Critical Psychiatry Textbook, Chapter 8: Depression and Mania (Affective Disorders) (Part One)

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Editor’s Note: Over the next several months, Mad in America is publishing a serialized version of Peter Gøtzsche’s book, Critical Psychiatry Textbook. In this blog, he discusses the drug industry’s influence in defining disorders and the lack of efficacy for depression pills. Each Monday, a new section of the book is published, and all chapters are archived here.

Depression pills are the most widely used psychiatric drugs, and brain scan studies play a major role when psychiatrists try to convince the world that these drugs are very useful and necessary.

In Chapter 3, I rejected the textbook claims that affective disorders may cause brain atrophy and other neurobiological changes. Only very rarely was there any admission or consideration that these changes might be caused by the pills rather than by the disease.

The textbooks had an array of extraordinary claims about what depression pills can accomplish in the brain. But there were no references, and what was claimed is highly unlikely to be true.

Close up photo depicting a man in a suit pouring two pills into his open palmWe are told that depression pills have an effect on neuroplasticity; that the pills stimulate the formation of new neurons and dendrites in the hippocampus;16:558 that brain scans have shown a decrease in atrophic changes with treatment; that animal studies have shown a very clear neuro-protective effect of the pills; that the pills can prevent nerve cell death, atrophy of nerve cells, and decreased neurogenesis, glial cell genesis, and angiogenesis; that there is much to suggest that treatment can lessen the structural pathological changes;16:267 that treatment can prevent deterioration if there are white matter lesions on an MRI;18:121 and that the atrophy of the hippocampus, which can be seen in long-term untreated depression, declines during effective treatment.18:126

The claim that the atrophy declines during effective treatment is a tautology. If it does not decline, the treatment was not effective. Evidence-based medicine (EBM) is about what a treatment does, on average. Does the treatment heal the claimed atrophy in the hippocampus compared to a group that was treated with placebo? We don’t know because such a trial has never been carried out.

We need not waste our time trying to find out which studies the psychiatrists didn’t quote, as we already know that brain imaging studies are grossly unreliable (see Chapter 3). Furthermore, if depression pills have no clinically relevant effects on depression; do not increase the patients’ quality of life; have common and disturbing adverse effects; and increase the risk of suicide, it is immaterial what happens in the brain.

This is exactly the case,6,7 which I shall demonstrate below. But first: why are so many people depressed?

Well, they aren’t really. Heavily pushed by the drug industry via psychiatric leaders on drug company payroll,6 the criteria for a depression diagnosis have been markedly lowered over the years, so that it now takes very little to get a diagnosis. Before we had depression pills, very few citizens ever got a diagnosis of depression.2 It was what we today call very severe depression, previously called melancholia, where people are unable to work for months. Many people feel sad from time to time, which is natural. This is not a disease, but today it is called a disease named not only depression but major depressive disorder to underline that you need professional help. Who would decline help if suffering from major cardiac disorder or from a major bone fracture?

In 2010, the US Centers for Disease Control and Prevention (CDC) published a report stating that 9% of the interviewed adults met the criteria for current depression.255 Do we believe that one-tenth of the US adult population is depressed at any one time?

We should reject this idea. The criteria the CDC used were those listed in DSM-IV (from the Patient Health Questionnaire [PHQ-9]) and very little was needed. You were depressed if you had had little interest or pleasure in doing things for more than half of the days over the past two weeks plus one additional “symptom,” which could be many things, for example, trouble falling asleep, or poor appetite or overeating. Little interest or pleasure in doing things for 8 days out of 14 will happen for most people sometimes. Trouble falling asleep is common, and many people overeat.

There is a substantial risk of circular evidence in all of this. In an interview, “The Creation of the Prozac Myth,” David Healy explained that if a new class of drugs affect mood, appetite, and sleep patterns, depression may be defined by industry-supported psychiatrists as a disease that consists of just that.256 The drug companies do not primarily sell drugs, they sell diagnoses, which is far more lucrative, and they sell lies about their drugs.1-11

In 2013, I was invited to speak at the Selling Sickness conference in Washington, DC, organised by Kim Witczak, whose husband Woody was driven into suicide by sertraline that was prescribed for insomnia but caused akathisia.7-89 Another speaker was science journalist Alan Cassels, co-author of the book, Selling Sickness: How the World’s Biggest Pharmaceutical Companies Are Turning Us All into Patients.129

The other author of Alan’s book was science journalist Ray Moynihan who played the role of a patient in a video about a new epidemic—motivational deficiency disorder.257 In its mild form, people cannot get off the beach or out of bed in the morning, and in its most severe form it can be lethal as the sufferer may lose the motivation to breathe. Moynihan says: “All my life people have called me lazy. But now I know I was sick.” Moynihan described the new disorder in the BMJ’s 1 April issue in 2006,258 and some people believed it was a true disease and asked where they could buy the drug against it, Indolebant.

Another video illustrated how easy it is to convince healthy people to take drugs they don’t need for a disease they don’t have. The Australian artist Justine Cooper invented a TV commercial that advertises Havidol (have it all), with the chemical name avafynetyme HCl (have a fine time plus hydrochloric acid).259,260 Havidol is for those who suffer from dysphoric social attention consumption deficit anxiety disorder (DSACDAD). Feel empty after a full day of shopping? Enjoy new things more than old ones? Does life seem better when you have more than others? Then you may have the disorder, which more than 50% of adults have. Havidol should be taken indefinitely, and side effects include extraordinary thinking, dermal gloss, markedly delayed sexual climax, inter-species communication and terminal smile. “Talk to your doctor about Havidol.” Some people believed that this drug was also for real and folded it into websites for panic and anxiety disorder or for depression.

I showed the two videos as an introduction to my talk about overdiagnosis and overtreatment when I lectured for over 100 psychiatrists in a hospital in Copenhagen in 2012. They laughed out loud but not when I added that what they had just seen wasn’t far from their everyday practice. All psychiatrists and family doctors should see these two videos as an antidote against the pervasive influence from the drug industry and their peers.

Bipolar in children rose 35-fold in 17 years in the United States,1:8 which is not only because of looser diagnostic criteria. Both SSRIs261 and ADHD drugs34 may cause mania, and their harms may lead to a diagnosis of bipolar disorder in one out of ten young people.262 However, leading psychiatrists hail this as “better” diagnosis, or they say that the drug unmasked the diagnosis.5:235 That psychiatrists are able to turn even serious drug harms around and make them look like benefits mirrors how the drug industry operates.

In 1987, just before the SSRIs came on the market, only 16,200 children were disabled mentally ill in the United States; 20 years later, it was 561,569, a 35-fold increase.1:245

In Denmark, sales of depression pills are now so high that 8.5% of the entire population can be in treatment with an adult dose every day for their entire life.263 This means that every Dane could be in treatment for 7 years. If this cannot wake people up, what can?

The drug companies are the drivers of this colossal overtreatment. In the period when the sales of SSRIs increased almost linearly by a factor of 18, the number of products on the market—and therefore the marketing pressure—increased by a factor of 16 (r = 0.97, almost perfect correlation).264 In the United States, the use of SSRIs and similar drugs almost tripled in primary care between 1989 and 2000, with each new agent adding to the aggregate use without a concomitant decrease in previously introduced newer agents.265

Depression pills don’t have clinically relevant effects on depression

Recent sharp increases in depression pill use have been accompanied by increased prevalence and duration of depressive episodes and rising levels of sickness absence from work.1:8,24

This is a general phenomenon for psychiatric drugs. In all countries where this relationship has been examined, the increased use of psychiatric drugs has been accompanied by an increase in disability pensions for mental health reasons.119:24 This is one among many indicators that the way we use psychiatric drugs causes more harm than good.

The placebo-controlled trials of depression pills are not of much use. As explained in Chapter 6, they are flawed for eight major reasons, which include the use of rating scales, lack of effective blinding in trials called double-blind, and withdrawal effects in the placebo group that are misinterpreted for depression symptoms.

One textbook claimed that imipramine, a tricyclic depression pill, removes the symptoms in patients with severe depression.18:307 This is impossible. No drug has ever been shown to cure patients with severe depression. But many psychiatrists believe that the old tricyclics, which they rarely use because of their harms, are more effective than selective serotonin reuptake inhibitors (SSRIs) and serotonin and norepinephrine reuptake inhibitors (SNRIs).

This belief is not based on reliable evidence. Half a century ago, trials were performed with tricyclics that were adequately blinded, as the placebo contained atropine,266 which causes dry-ness in the mouth and other adverse effects similar to those seen with the tricyclics. The trials were therefore much more reliable than those using conventional placebos.

A review of nine trials (751 patients) with atropine in the placebo failed to demonstrate an effect of tricyclics.266 The measured effect, a standardised mean difference of 0.17, was not only statistically uncertain (the 95% confidence interval went from 0.00 to 0.34), but so small that even if it were true, it would have no clinical relevance. The effect was 0.39 if all studies were included, but there was a single strongly positive trial, and the authors obtained the more reliable result of 0.17 after they had excluded it from the analysis. This is the appropriate thing to do. Fraud is the most common reason that one study is an extreme outlier (in this case, the effect size was 1.1).

An effect of 0.17 is tiny. In the clinical study reports of depression pills I obtained from the European Medicines Agency, the median standard deviation on the Hamilton scale after treatment was 7.5. This means that 0.17 corresponds to a change of 1.3 points on the Hamilton scale, which ranges from 0 to 52. The smallest effect that can be perceived on this scale is 5-6 points.267 The minimal clinically relevant effect is of course larger than the bare minimum that can be perceived. That you can see light at the end of the tunnel doesn’t mean there is enough light to read a newspaper and your depression doesn’t lift just because your psychiatrist has noticed a tiny change.

The placebo-controlled trials of SSRIs and SNRIs are not only flawed because of the lack of adequate blinding but also because virtually all patients were in treatment with a depression pill before randomisation. This creates a huge bias because of withdrawal effects.7:244 Many of the withdrawal symptoms are the same as the symptoms that define depression, and the researchers therefore make a wrong conclusion when they say their trial showed that the drug worked.

Some meta-analyses have found that the effect of depression pills is larger if the patients are severely depressed,268-270 and all over the world the pills are recommended for severe and usually also for moderate depression even though one textbook noted that the effect of the pills is the same or less than that of cognitive behavioural therapy in moderate depression.19:293

It is difficult to believe that an intervention that doesn’t work when tested in patients with all disease severities, including many with severe disease, should work for those most affected. The difference between the drug and placebo is only about 2 points on the Hamilton scale,268,271 even though the trials are flawed in favour of active drug.

The reported effect is also small and irrelevant for patients with very severe depression, e.g. only 2.7 points for patients with a baseline Hamilton score above 23,268 which, according to the American Psychiatric Association’s Handbook of Psychiatric Measures, is very severe depression.270 The effect is 1.3 points for milder degrees of depression,268 but this difference is likely just a mathematical artefact.272 Since the baseline scores for severe depression are larger than for mild depression, any bias will influence the measured result more in patients with severe depression than in those with mild depression. If we assume the bias caused by insufficient blinding because of the drugs’ adverse effects is 10% when estimating the effect in the drug group,7:51 and, for the simplicity of the example, that there is no bias in the placebo group and no improvement between baseline and the final visit, then a Hamilton baseline score of 25 would still be 25 after treatment. But because of the bias, there would be a 2.5-point difference between drug and placebo. If the baseline is 15, that difference would only be 1.5.

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19 COMMENTS

  1. “In 1987, just before the SSRIs came on the market, only 16,200 children were disabled mentally ill in the United States; 20 years later, it was 561,569, a 35-fold increase.1:245”

    The crimes against humanity (especially our children), that the psych “professionals” are still committing, are just appalling.

    Thank you, Dr. Peter, for speaking the truth.

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  2. A common mainstream media way to explain the correlation between increased disability pensions and psychiatric drug usage is to explain it as a positive thing: That people who need help are now getting it.

    Therefore a strong possibility of hurting people is transformed as a sure marker of advancement of society and medical science.

    There is a way to verify that, but it is never considered in TV talk shows. If that “ill people are now getting help” argument would be true, then we should see positive long term results associated with psychiatric treatments, because they would be unrelated to disability pensions.

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    • Exactly. If the current model were working, people who USED TO BE disabled would now be OFF disability and working again! If someone’s disabled with, say, a bad knee, and gets knee surgery, we would expect that the corhort of such people would be LESS disabled than before the surgery! There may be a few for whom it did not work and they didn’t get better or got worse, but overall, the average disability level would have to go DOWN for this intervention to be considered effective! If people are MORE likely to be unable to work and participate in society AFTER receiving psychiatric “treatment” than before – well, there isn’t a much better definition of “ineffective” or indeed “counterproductive” available than having a “treatment” actually INCREASE the disability rate of its recipients!

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  3. Psychiatric textbooks are based on research bankrolled by drug companies.

    And drug companies are paid by insurance companies.

    And guess who bribes (opps! I meant “contributes to”) the politicians who greenlight this whole shebang???

    And as long as medicine remains a for-profit system, not much will change.

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    • In Northern Countries in Europe that money source is mainly from the state instead of insurance companies, but the situation is similar. So I believe that the for-profit system is not the main culprit.

      But it seems that compulsory insurance and state money is the main fueling force for psychiatry.

      Every social system has rules and those unable or not willing to follow them are currently considered as sick. That is a world wide policy and the source of the psychiatric money flow.

      What bugs me is that those opposing psychiatry usually feel that they are fighting against drug companies, when the roots of the problem run much deeper. Democratically and legally decided rules cause great suffering and disability and loneliness and lack of skills to quite a big group of people and that suffering and disability is described as something being mentally or biologically wrong in those individuals.

      Doctors are just given the job to handle them as sick and disturbed persons. That is likely the source of not wanting to blame the environment, because blaming the environment would mean going against laws governing us and people enforcing them and against the feeding hand.

      Psychiatric services are extremely helpful for police and teachers and parents and caretakers of elderly and local communities when anyone suffering from common rules and therefore opposing them, or not being able to follow them while trying, can be considered as dangerous and ill, because when trying to make his life bearable he causes discomfort and damage.

      That means focus with psychiatry is not actually on helping, but is more like an outer form of law enforcement. Helping those with diagnoses would mean going against perfectly healthy and sane people that form the ruling class in groups and forcing them to change their behavior and therefore causing them anxiety and threatening them.

      Those “affective disorders” are mostly born when some individual is forced to try more than he can endure with his skills prolonged times. After that behavior he has learnt is indeed part of the problem and can be helped with therapy, but that behavior is born from the impossible situations when trying more is the only option.

      After too much trying brain functions start to close themselves leading into depression symptoms and if the individual continues trying then he gets an ability to force his mood up to be able to do what he is forced to do by the rules. That trying more than a natural limit can also be caused with substances that accelerate the nervous system like ADHD medicines.

      Both depression and mania can be turned into psychosis when forced trying continues and starts affecting memory and makes thinking hurt, making people naturally try to seek isolation from any changes in environment, because any change elevates brain usage and therefore hurt and causes disability.

      It is such a simple pattern. Almost the only thing lacking in that explanation is the matter of skills. Our nervous system does some learning automatically independent of our decisions and the group of people lacking those skills are currently diagnosed as having neurodevelopmental disorders like ADHD and autism and others.

      At the moment when an automatic learning process comes too difficult we naturally do something else or seek rest or try to elevate our mood to make processing easier. That includes methods like moving or raising voice or using imagination or cursing or causing pain or masturbating. If that does not succeed then neurological development disorder turns into affective disorder or psychosis. Many people with “psychiatric disorders” also use those methods of raising the mood, because it often enables them to follow the rules and be happy and then they are left wondering why it sometimes helps and sometimes not.

      So I believe that we should focus more on why people have to learn that behavior. What is currently considered as a sickness or disorder is usually the only possible way to try to survive under harsh exceptions that come from those individuals that are given local or statewide authority.

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      • “In Northern Countries in Europe that money source is mainly from the state instead of insurance companies, but the situation in similar. So I believe that the for-profit system is not the main culprit.”

        “But it seems that compulsory insurance and state money is the main fueling force for psychiatry.”

        “What bugs me is that those opposing psychiatry usually feel that they are fighting against drug companies, when the roots of the problem tun much deeper.”

        The for-profit system is indeed one of the main culprits. But state-run systems also place economic interests ahead of individuals, and therefore are no better at respecting the rights of individuals than other systems of government.

        And people don’t “feel” they are fighting against drug companies, they ARE fighting against drugs companies because drug companies run psychiatry. And drug companies are a huge part of the world’s economy and their influence over governments should never be underestimated.

        And there are many who believe that people’s so-called “psychiatric” problems were made worse with the emergence of the Industrial Revolution, a revolution that continues in both state-run and for-profit economies; and one of the most blatant examples of this is the invention of psychiatry’s DSM “diagnoses” and the subsequent marketing of Prozac in the late 1980’s. In other words, psychiatry has become the foundation of an economically driven world.

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      • Some people believe that psychic distress is primarily caused by unprocessed intergenerational family trauma that unfortunately often morphs into lust for power, greed and exploitation, the unhappy results of which are hidden euphemistically by psychiatric “diagnoses”.

        There’s a lot on this subject in books by Alice Miller.

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  4. While I tend to agree that over diagnosis of psychiatric disorders is an issue, as I encounter it often when I am evaluating patients in my psychiatry practice. HOWEVER, I would appreciate more accuracy in your article. The PHQ-9 is an assessment tool, NOT a diagnostic tool. In order to get an accurate diagnosis of major depressive disorder, much more criteria than what the article postulates is needed. The full criteria are listed in the dsm 5 (the Diagnostic manual). Part of the problem with over diagnosis is that you have Primary care doctors like yourself, diagnosing people with psychiatric disorders that aren’t educated about the criteria of these disorders and are not educating themselves about how to correctly diagnose these disorders. The misinformation in this article is evidence of this occuring. Perhaps Mad in America needs to have people fact check these articles so that we can all read about issues that absolutely need to be talked about in psychiatry, without spreading misinformation while doing so.

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    • The problem is not that people don’t fully use the criteria (even though they almost never do), it’s that the criteria themselves are subjective, speculative, and completely unscientific in nature. You can’t judge “overdiagnosis” if there is no objective way to tell who “has” or “does not have” a particular “disorder.” The DSM itself admits in its introduction that 1) you can’t really tell who has which “disorder,” or where the line between “disorder” and “no disorder” can be drawn, and 2) any two people who COMPLETELY FIT the criteria at a given moment may not have the same problem or need the same kind of help. Of course, almost no one ever READS the introduction, and it’s couched in very squirmy language that requires interpretation, but it’s a pretty damning admission, don’t you think? We have no way of objectively determining which diagnosis you have, and even if you and another person are right in the center of the target, your diagnosis means nothing about the cause or your needs or what treatment to recommend. What is the value of such a “diagnosis?”

      When I did clinical work in the past, I simply talked to the client about his/her own conception of the problem and what they thought might have helped. While of course I asked good questions and made observations and brainstormed options with the client, in the end, the client was responsible for defining the problem and whether or not a particular intervention was “working.” It is arrogant in the extreme in my view for a clinician to enforce his/her views on what is “wrong” or what “should be done” on a client, as the main reason people suffer from “mental health issues” in the first place, ESPECIALLY when we’re talking about depression and/or anxiety, is because OTHER PEOPLE have taken over their lives and told them what to think, say or do and what was “right” in opposition to allowing the to follow their own personal “voice.” I consider it more abuse for a “professional” to boss a client around and disempower them the way they were disempowered by others in their pasts. Empowerment is the answer, not more powerful people exerting their control over the clients’ lives.

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    • Paula,
      If psychiatry’s so-called “diagnoses” are as accurate as you claim, why do the labels and criteria keep changing? And why is it that different psychiatrists come up with different “diagnoses” for the same person at approximately the same time?

      It seems to me that you’re ignoring the fact that your so-called “psychiatric diagnoses” are nothing but a laundry list of vague complaints that can be attributed to any number of things for any number of reasons to any number of people, including yourself.

      The time has come for you and your colleagues to finally admit that handing out “psychiatric diagnoses” is nothing more than an expensive game of “Pin The Tail On The Diagnoses”.

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    • Depression is a real problem. No doubt. And it can get extremely bad to the point of severe dysfunction. I want to take nothing away from whatever helps people. Not pills, not ECT…none of it (not personally).

      But have you ever considered trying to put “diagnoses” like “Major Depressive Disorder” in the bin where they belong? If a person comes to you for help and says “I need help but please don’t put psychiatric labels on my file”, would you do it?

      Those categorisations explain nothing. Chicken pox/varicella virus is a diagnosis that explains a person having a fever and blisters over his skin.

      All you are doing is rewording behaviour and making it appear like it’s a “diagnosis”. No point bringing up syndromal diagnoses in physical medicine because they do not pertain to the mind, i.e. they have nothing to do with character, conduct, mood, personality, sanity etc. Their implications on a human being’s life are not the same.

      And it won’t end at “Major Depressive Disorder” for a lot of people. They will graduate onto further psychiatric categorisations as “comorbidities”.

      But please consider not just the problems people come to you with, but the social, legal, medical and personal damage that comes from the terms you stamp them with, whatever their problems might be. If people find such terms useful, let them have their “diagnoses”. It should not be forced onto them because it is not required at all except for insurance purposes (what if someone pays cash?).

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  5. And in walks the necessity for financial mgt by the ever growing ‘special needs/disability’ and ‘elder law’ industry which is going gang busters with the baby boom generation rolling forward trying to pass on generation wealth while minimizing taxes and keeping assets protected.

    Diagnosis with depression at any age for any reason is cause for full guardianship and conservatorship of assets/money. Old, need your money managed by somebody.
    Depressed = mentally disabled and unable to manage money.

    So assets are controlled by court, a paid fiduciary is entrusted to handle and full guardianship plus conservatorship is approved by court for convenience of the paid assigned ‘fiduciary’.

    Fiduciary then has full authority to dictate treatment, which treatments, how much treatment even where a person lives, friends, medications taken/allowed and core thungs such as ability to vote.
    When COVID first hit, all of these guardians/conservators – many are piped in by the social work/mental health profession, were, by law, putting DNR on all wards.

    REGARDLESS OF INDIVIDUAL’S CIRCUMSTANCES.

    Family has no say so, either, once a guardian/conservator is on the case.

    And whom frequently signs this paperwork for mental incapacity?

    PSYCHIATRISTS.

    Who is then forced to pay the fees for guadrian/conservator?

    The individual via all assets.

    When not enough money then tax dollars pay.

    There is a direct correlation btwn age, mental disability and dramatic increase in overuse of probate court and guardianship/conservatorship increases in last decades.

    Same timeline as prozac hitting market.

    It’s now so prevalent, overuse of guardianship/conservatorship measures and every po dunk weezle pal of a social worker looking to make fast, big bucks acting as professional fiduciary plus guardian/conservator that it’s a billions of buck/year industry. So bad now that the US DOJ has opened several ‘elder abuse task force offices’ around the USA.

    But elderly aren’t only persons impacted…many more are disabled persons-physically, mentally or even with just a bought of melancholia, SSRI/SNRI induced anything, or even just one simple broken leg rendering a person unable to work for a few months. Secure that medical insurance by medicaid/medicare by ensuring injured person stays 600% below the federal poverty line in monthly income, so move assets into fiduciary acct…fiduciary is frequently a social worker or a lawyer who has given up law because professional fiduciary biz is just so lucrative and mostly unregulated and barely monitored even when court ordered.
    Completely unmonitored by court when fiduciary acts as trustee for private account with even low assets in estate/trust to billions.
    Professional fiduciary need only be a high school graduate. Nothing else. There is such a huge mess in our state, Michigan, right now. Professional fiduciary with only previous legal experience was working herself through her own personal bankruptcy and her ‘years of financial experience’ working as a ft cashier at a McDonald’s in AZ for 10 years.

    Moves home to this state after train wreck of a life for first 35 years and pipes into mental health system because of a family member (bro) manic Diagnosis (he suicided recently) and her adult daughter being diagnosed for 7 years (so far) with post partum depression- so she’s seeing the big bucks, way to control hundreds of people’s millions in assets and then be able to pay herself, barely unmonitored fees even in court supervised cases. It’s a great way to work around her damning, permanently scared financial track record of bankruptcy and lackluster work history.

    She becomes a ‘professional fiduciary’.
    With this, she’s now acting as a trustee for family estates with billions in assets.

    How does a high school graduate, bankrupting, McDonald’s employee become a trustee for millions of dollar estates and trusts?

    Because she ‘networked’ into the social worker ring from the mental health clinic.

    I am now very distressed and am having panic attacks and suffering from traumatic reactions because she forced herself onto our family assets and trust as ‘the only trustee option available in this section of the country’ according to my original atty who turned out to be her business partner.

    The easiest way to get such control of assets is to claim that anybody targeted has a mental problem regardless of reason – age, bump on head, or even side effect of treatment such as steroids used for inflammation. Steroids cause high energy or ‘mania’ even with micro doses used for but a few months.
    According to DSM, more than a few weeks then a person is manic, bi polar and the psychiatrists frequently just refuse to acknowledge such a thing.

    Any SSRI/SNRI pusher refuses to acknowledge that these medications don’t work or that the side effects are so much more damaging than even the few temporary subjectively noticed improvements are only seen in so few patients.

    It’s all such a sham.

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