For almost half a century, psychiatry’s narrative has been that we have effective and safe drugs for depression that fix a chemical imbalance. Even though none of this is correct, and even though the false narrative is harmful for the patients, health professionals, drug agencies, medical journals and the media are doing their best to maintain it. I shall illustrate this with two recent examples.
False statements in package inserts about a chemical imbalance
In January 2025, I notified the UK drug regulator, the Medicines & Healthcare products Regulatory Agency (MHRA), that the package inserts for antidepressants — called patient information leaflets (PIL) — contain false statements about depression being caused by a chemical imbalance, and I called for the misleading messages to be removed.
Depression is almost always caused by depressing life events or living conditions. As a patient once said to his doctor, “I don’t want an antidepressant, I want a job!” However, most patients are told they are depressed because they have a chemical imbalance in their brain and are then prescribed a pill that is supposed to fix this problem. This lie is very harmful. When patients are told there is something wrong in their brain chemistry that a drug can fix, why should they ever stop? Most patients on depression pills take them for many years.
No reliable research has ever shown the existence of any chemical imbalance causing depression, and in 2022, a comprehensive literature review by psychiatrist Joanna Moncrieff and colleagues showed that there is no support for saying that depression is caused by a lack of serotonin in the brain.
As I have described on Mad in America, the MHRA refused to make any changes. The MHRA is primarily funded by the drug companies it is supposed to be regulating. We must insist they overcome this conflict of interest and change their false and harmful information.
With Joanna Moncrieff, Gabriel Symonds, and John Read, I sent the above information as a letter to four major UK newspapers, The Guardian, The Independent, The Times, and the Daily Mail. We also called upon the Royal College of Psychiatrists to support us and the patients by demanding of the MHRA that they don’t propagate untruthful statements in their information to patients. As the Royal College has no email address on their website, I used their contact form, enclosing our letter to The Guardian, with this message:
To the Royal College of Psychiatrists
Psychiatry’s biggest lie: “Your depression is caused by a chemical imbalance”
Please see attached letter, particularly its last sentence. We sent this letter to The Guardian today as our first try. You might not be able to see the hyperlinks.
We very much hope you will support us, thereby supporting hundred of thousands of patients who wrongly believe that their depression is caused by a chemical imbalance in the brain, which is one of the reasons why many patients stay on their drug for far too long, sometimes even for the rest of their lives.
We look forward to your reply.
None of the four newspapers or the Royal College had the courtesy to reply. The media and the leading psychiatrist organisation in the UK don’t seem to care that our drug regulators lie to the patients about psychiatric drugs, even though these drugs are so overprescribed and so harmful that they are the third leading cause of death.
In New Zealand, psychologist Giselle Bahr and other health professionals got nowhere when they approached MedSafe — the New Zealand drug regulator. They then contacted the drug companies and persuaded the suppliers of amitriptyline, citalopram, clomipramine, dosulepin, mirtazapine, and paroxetine to remove the chemical imbalance statement from their Consumer Medicine Information. The suppliers of escitalopram (Lundbeck) and imipramine (AFT Pharmaceuticals) refused to comply. And a government regulator, the Commerce Commission, refused to raise this matter with the companies.
What should we do? I don’t regret that I called my most recent book about psychiatry, “Is psychiatry a crime against humanity?” It surely is and those who can accomplish the much-needed changes, turn their back to the atrocities. The book can be downloaded for free here.
How to avoid weighing the benefits and harms of SSRIs in a Lancet editorial
On 10 May 2025, an anonymous editorial in The Lancet, “50 years of SSRIs: weighing benefits and harms,” did little of what its title promised. I submitted a comment (700 words allowed) where I tried to be as gentle as possible to increase my chance of having it published.
It was rejected right away and I was told I could submit a letter to the editor. You have to be really quick, as you must submit it within two weeks after the publication, and brief as well, as only 250 words and 5 references are allowed.
There was therefore no room for my pleasantries. My letter was rejected on 23 June after it was discussed with the Editor-in-Chief, Richard Horton, whom I assume wrote the editorial: “weighing it up against other submissions we have under consideration, I am sorry to say that we are unable to accept it for publication.”
I expected this outcome because my letter explains why the editorial is meaningless and seriously misleading. Here it is, but see also my additional points after the references:
The Lancet did not really weigh benefits and harms.1 The effect of SSRIs on depression is far below the least clinically relevant effect.2 And the patients don’t like the drugs, they prefer a placebo: 12% more patients dropped out for any reason while on drug than on placebo.3 And half the patients have their sex life disturbed or made impossible by the drugs.2
FDA’s 2004 black box warning was not about a “possible” increased risk of suicidality in young adults. It was real and documented in the placebo-controlled studies. Furthermore, the drugs double not only the risk of suicide, but also actual suicides, and not only in children, but also in adults.4
First-line treatment for severe depression should not include an antidepressant. In contrast to pills, psychotherapy has an enduring effect2 and a systematic review showed it halved the risk of new suicide attempts in people admitted to hospital after a suicide attempt.2 Moreover, the widespread belief that the drugs are more effective in severe depression is wrong. It is based on mathematical artefacts,2 and even if the bias is ignored, the drugs do not provide clinically relevant effects in very severe depression.2
The balance between benefits and harms is negative for depression drugs. It is noteworthy that the World Health Organisation has recently called for urgent transformation of mental health policies, with a psychosocial focus, informed consent, no coercion, and less drug use.5
Declaration of interests: I have no conflicts of interest.
References
1 50 years of SSRIs: weighing benefits and harms. Lancet 2025;405:1641.
2 Gøtzsche PC. Critical psychiatry textbook. Copenhagen: Institute for Scientific Freedom; 2022. https://www.scientificfreedom.dk/books/ (freely available, accessed 13 May 2025).
3 Sharma T, Guski LS, Freund N, Meng DM, Gøtzsche PC. Drop-out rates in placebo-controlled trials of antidepressant drugs: A systematic review and meta-analysis based on clinical study reports. Int J Risk Saf Med 2019;30:217-32.
4 Hengartner MP, Plöderl M. Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s ReAnalysis.” Psychother Psychosom 2019;88:373-4.
5 New WHO guidance calls for urgent transformation of mental health policies. WHO 2025; Mar 25. https://www.who.int/news/item/25-03-2025-new-who-guidance-calls-for-urgent-transformation-of-mental-health-policies (accessed 13 May 2025).
Additional points
I included some of the points below in my submitted comment. For example, I praised The Lancet for acknowledging the important work of Joanna Moncrieff and for acknowledging that SSRIs can cause a protracted withdrawal syndrome, necessitating a gradual tapering when they are stopped. This is essential to know, as psychiatrists and other doctors virtually always mistake withdrawal symptoms for relapse (see my Critical Psychiatry Textbook), which tends to keep the patients on drugs they don’t need for decades.
Lancet noted that, “For many, SSRIs have been profoundly helpful in managing their health and continue to have an important place in care.” This is the mantra the media always use. Where are all those “many”? We cannot see them, and, given that the drugs provide no meaningful benefit over placebo and have substantial harms, SSRIs are not profoundly helpful. People become better over time but this is the spontaneous improvement that would have occurred also without drugs.
Lancet misrepresented Joanna’s book Chemically Imbalanced. The editor referred to a 2002 meta-analysis she mentions, which concluded that the effects of SSRIs are clinically negligible compared with placebo. And then says that “other studies have shown effectiveness, including a 2018 meta-analysis in The Lancet, which concluded that all antidepressants are more efficacious than placebo in adults with a diagnosis of major depressive disorder, with odds ratios ranging between 2.23 and 1.37.”
This is extremely misleading. First, Lancet failed to note that Joanna, in her book, comprehensively deconstructed the Lancet 2018 meta-analysis by Cipriani and colleagues, and moreover, she doesn’t rest her case on a single meta-analysis from 2002.
Second, the 2018 meta-analysis is so flawed that I published the article, “Rewarding the companies that cheated the most in antidepressant trials” and my research group showed that the outcome data differed from the clinical study reports in 63% of the trials; that the effect of the drugs was higher in published than in unpublished trials; and that there was a high risk of bias in the trials.
Third, the effect in the Cipriani review is very similar to that estimated in other reviews and so small that it lacks any clinical relevance (effect size 0.30), which Joanna, I and others pointed out in a letter to the editor of The Lancet.
Fourth, it is highly misleading to dichotomise a ranking scale outcome, which we also pointed out. The odds ratio gives a false impression of the effect of the drugs.
According to Lancet, “Some psychiatrists have argued that delineating a clear mechanism of action is unimportant as long as the treatment is effective.” The trouble with this argument is that the drugs are ineffective.
We were also told that “fluoxetine transformed the treatment of depression and associated psychiatric conditions.” This was meant to be positive, but it isn’t. After its launch, fluoxetine quickly became the most complained-about drug, with hundreds of out-of-character suicides and homicides. And, as David Healy and I recently demonstrated, the two pivotal fluoxetine trials in children were fraudulent.
Lancet said that “First-line treatments for more severe depression should be individual cognitive therapy combined with an antidepressant.” However, in contrast to pills, psychotherapy has an enduring effect (see my Critical Psychiatry Textbook) and it can halve the risk of new suicide attempts in people admitted to hospital after a suicide attempt. Moreover, the widespread belief that the drugs are more effective in severe depression is wrong. It is based on two mathematical artefacts, and even if these biases are ignored, the drugs do not provide clinically relevant effects in very severe depression.
Lancet also argued that “many general practitioners are pressed for time and short on options. A pill, the reasoning goes, might be better than nothing.” It isn’t. Doing nothing is better than prescribing a pill, and psychotherapy is better than both options.
We need to change the false narrative. The balance between benefits and harms is negative for depression drugs, and we have a mental health crisis because the existing drug focused approaches are not working. The World Health Organization has recently called for urgent transformation of mental health policies, with a psychosocial focus and less drug use.
What the Lancet editorial illustrates is that we should regard traditional medical journals as more or less dead. This is not where we can expect to be informed in the most reliable way. Horton has himself stated that “Journals have devolved into information laundering operations for the pharmaceutical industry.” The Lancet is certainly no exception to this.
Estimado Sr. Gotzshe,
Creo que hay pocos testimonios de cómo trabaja el antipsicótico en la percepción interna de los tratados. Le escribo lo que he podido analizar después de más de 40 años de consumirlos. Actúa cual centinela químico represor.
LA ANTIPSICOSIS: enfermedad
La antipsicosis es una enfermedad cerebral inducida por el consumo prolongado de antipsicóticos, o sea hablamos de iatrogenia. Produce una modificación estructural en las neuronas de imposible deconstrucción, al menos hasta hoy.
Por ese motivo no se puede concluir la desmedicalización cuando se intenta y se manifiesta el síndrome de abstinencia que se explica como manifestación de “enfermedad” por adoptar una forma de “psicosis”.
Aunque no sería imposible sospechar que ya exista su antídoto.
El comienzo del consumo es altamente traumático que marca psíquicamente para toda la vida.
Suele iniciarse en hospitalización psiquiátrica, para una supuesta psicosis, que se interpreta superada parcialmente a las pocas semanas de la ingesta del antipsicótico por la mejoría del estado del enfermo, pero en realidad se debe a una rápida adaptación orgánica a la toxicidad del fármaco.
Se recibe el alta pasados unos días. Se considera popularmente como un avance en el tratamiento clásico de la locura. “En los manicomios estaban peor”.
Una vez fuera del hospital, se le prescribe el fármaco para ingerir de manera continuada. Si antes de los seis meses vuelve a reproducir una situación crítica se dirá que la afectación de la enfermedad es crónica, y por lo tanto de ingestión obligada y continuada del fármaco con control médico.
Esta primera crisis nada tiene que ver con lo que le condujo a urgencias, la sintomatología es diferente, quizá llegó con una exacerbación originada por cuestiones sociales y acaba con manifestaciones psicodélicas de procedencia tóxico-química.
Pero nadie ha dicho todavía que esa crisis anterior a los seis meses se deba a la activación de la molécula residente en las neuronas ante la mínima excitación neuronal consciente o inconsciente del afectado, como así es.
Y las llamadas recidivas se seguirán manifestando según esa lógica porque el sujeto se sigue administrando lo que las desencadena, el propio fármaco.
¿Todos están engañados?
No solo el fármaco se expresa como “vigilante” del estado neuronal del afectado produciendo recidivas, también produce sintomatología negativa, como aplanamientos en el aspecto cognitivo, funcional, afectivo, etc. y efectos secundarios como acatisia, sobrepeso, dificultad de concentración, etc.
El afectado queda condicionado en el amor y el trabajo, y su destino es depender de una pensión que será mínima por no haber trabajado y contribuido a la Seguridad Social, porque este drama suele darse en la juventud cuando no ha comenzado su vida laboral. Y quizá ya no la comience, quedando al cuidado de los familiares y finalmente en la indigencia.
Además, y sin información previa de su riesgo y peligrosidad, (cuyas consecuencias se harán recaer sobre al afectado cuando inicie la reducción o abandono por su cuenta del fármaco), experimentará acciones impulsivas que serán atribuidas a su “enfermedad”.
Del síndrome brutal de abstinencia nadie le había advertido. De entrada, todos defenderán que es producto de la enfermedad, incluso él lo cree, pero después de diversos intentos de reducción o abandono, queda claro que la coincidencia cronológica de la aparición de esos estados se debe a la mecanicidad de la química.
Sorpresivamente, a las horas o pocos días de la reducción de la dosis, aparecen acciones impulsivas con las que no me identifico, que alteran la vida familiar y social. Tengo dos opciones, o voy al psiquiatra y se lo cuento y consecuentemente me subirá la dosis con mi desagrado, o me digo “a lo hecho pecho” y dirimo la situación como puedo. Y eso, eso es lo que se interpreta como insensibilidad psicótica… y no lo es. ¿Lo entienden?
Claro que los psiquiatras suelen ser prudentes y toman medidas para no ser objeto de la violencia de sus tratados, pero sepan que, si en algo el afectado expresa impulsividad, no es por su condición patológica, sino por la presión social que se ejerce sobre él y quizá también por el síndrome de abstinencia que he comentado. Administrar pastillas puede equivaler a repartir munición. Esa es la explicación y no otra.
Adquieren la reputación de delictivos los intentos de reducción de dosis. Pero nadie compartirá responsabilidades de esos actos, de hecho, los médicos evitarán dar mucha información que les comprometa. El “no sabemos” y el “no decir” es el mantra que les protege.
El caso del avión estrellado de Germanwings, tan relacionado con los psicotrópicos, ¿no les hace pensar?
El psiquiatra está para evitar que atentes contra ti y contra terceros, pero por ignorancia te pueden desgraciar la vida de otras maneras.
En muchos casos, los ingresos hospitalarios se reproducen de manera periódica y continuada, la llamada “puerta giratoria”.
La degeneración personal del afectado es progresiva si no mantiene una actividad que el propio antipsicótico acaba imposibilitando con su sedación extrema. El enclaustramiento ya es irreversible.
La participación colaborativa con el sistema por parte de la familia como de la sociedad es decisiva, para acatar el dogma psiquiátrico y el consecuente estigma que se deriva del diagnóstico.
¿Hay maldad?
La antipsicosis es el avance de un mal que nadie reconoce para evitar las consecuencias penales que tendrían. Siendo así, es un asunto que queda velado por un sinfín de actos reputados de profesionales y benéficos.
Queda fijado como cuestión sistémica, más allá de intenciones humanas, y combatirla comporta no mirar a ningún humano o sustancia, sino a entes ilocalizables e incorpóreos. Pero esto ya es entrar en otra disciplina ajena a la medicina.
¿Se podrá hablar sin tapujos de esto dentro de cincuenta años?
Déjense de tratar la esquizofrenia, la bipolaridad y aborden la antipsicosis en primer lugar. La esquizofrenia ahora es antipsicosis.
La lobotomía ha quedado en el imaginario colectivo como algo horripilante, pero hasta el día de hoy los antipsicóticos han producido más víctimas que las que en su día produjo aquella cirugía.
¿Qué hacer? No sé, ustedes son médicos. Con menos arte y ciencia, siempre ha habido medicina, y siempre ha habido curas.
Porque siempre ha habido enfermos.
Yo solo digo lo que NO es medicina. Que ya es mucho desde una posición tan básica como la mía.
El médico gestiona los efectos nocivos de una química, no una enfermedad, regula la dosis en un raro equilibrio entre los polos del síndrome de abstinencia y la recidiva.
No deberían gestionar ni química ni enfermedad, deberían “torear”, si saben, el aspecto “disciplinario” que es el verdadero padecimiento del afectado.
Y afectados somos todos, sanitarios, pacientes y el pueblo en general. En el meollo de la salud mental hay un asunto político. No digo que en otras especialidades no esté, ahí no llego.
La psiquiatría siempre será la avanzadilla de esa lucha, ¡no renunciamos! La psiquiatría es la esperanza de la acción médica más general. Aquí nos vemos con los demonios cara a cara, pacientes y terapeutas. Eso sí, siempre les caracterizará la contradicción y a veces tristemente la comisión de errores garrafales.
¿Cuál es mi enfermedad? Pues que, al error de mi juventud hube de añadir el acoso moral y repudio de mi familia. Y no le den más explicaciones ni hurguen más en el cerebro.
Pero sí, por obra y gracia de la medicina al uso, padezco la antipsicosis desde que ingerí el primer antipsicótico allá por diciembre de 1980, hace ya más de 44 años, por lo que hoy por hoy me es imposible dejar la medicación, a menos que ustedes sepan lo que yo no sé.
Sí, les necesito, necesito esa droga, soy drogodependiente.
Y quizá ustedes también me necesiten a mí.
¿Qué tal si ustedes y yo nos liberamos?
P.S.: Para hacer pedagogía del consumo de antipsicóticos se recurre a la comparación con los diabéticos. Pero si un diabético llegase a morir por no administrarse insulina, sería por la diabetes, en cambio si un psicótico llegase a morir por no tomarse el antipsicótico sería por el antipsicótico. Esa es la diferencia.
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Would anyone choose to take these drugs were they to be afforded Fair, Full and Informed Consent?
Why should committed doctors and vulnerable patients choose to prescribe/take a ‘treatment’ that causes AKATHISIA, DISINHIBITION, EMOTIONAL LABILITY, INCREASED SUICIDALITY, DESTRUCTION of SEXUALITY, POST SSRI SEXUAL DYSFUNCTION (and for some, intolerable withdrawal syndromes) – were they to be informed of these Adverse Drug Reactions (ADRs)?
When are prescribers going to ensure that AKATHISIA is immediately recognised as an ADR, and not misdiagnosed as ‘Serious Mental Illness”?
Where is the professional Duty of Candour? Where is professional accountability?
Thank you Professor Gotzsche.
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Thank you, Dr. Gotzsche, for your courage and perseverance in speaking the truth about these harmful drugs. Drugs should never be the first line of treatment for any mental health condition; the risk of potential harm is too great. Information is coming to light that depression has more to do with our gut than our brain. Also, the field of Metabolic Psychiatry has really taken off, and it’s very exciting to see.
It’s sad that these powerful organizations continue to cling to false narratives around the chemical imbalance theory. When something is so deeply ingrained in society, it’s hard for people to accept that it could be wrong.
Keep up the great work that you and others are doing.
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Excellent work, Dr. Gøtzsche! And thank you SO much for giving free access to your valuable research…not often seen in the academic world. You can be sure I will be using your writing to support my essay that deals with how psychiatry has maintained this status quo for such a lengthy period.
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Psychiatrist Prof. Dr. Peter Breggin had a saying, ‘A chemical imbalance is an imbalance that psychiatrists put in there (the brain) with their drugs.’ Very true…
In one study, a person with a ‘mental health problem’ who had never used psychiatric medication in his life… was subjected to biological and radiological tests such as MRI, X-ray, ultrasound, blood etc. before using psychiatric medication. Especially in radiological tests such as MRI, X-ray and/or ultrasound… it was observed that the individual’s brain was ‘extremely healthy’.
After the tests, the individual was given psychiatric medication. Shortly after, he was subjected to biological and radiological tests again. This time, radiological tests also observed ‘abnormal changes’ in the individual’s brain.
These abnormal changes in the brain… are ‘inversely’ consistent with the thesis that ‘mental illness is caused by a chemical imbalance in the brain’ that ‘psychopathic mainstream psychiatry’ has been expressing for years. This is the ‘reverse terminology’ reaction of psychiatry. It is distorting the events and the causes. Mainstream psychiatry… It is turning the ‘chemical imbalance in the brain’ caused by psychiatric drugs… into the LIE that ‘mental illness is caused by a chemical imbalance in the brain’.
Presumably ‘psychopathic mainstream psychiatry’… knew long ago that psychiatric drugs create (measurable/testable) chemical imbalances in people’s ‘healthy brains’. He distorted this information into the LIE that “mental illness is caused by a chemical imbalance in the brain.” And humanity, unaware of everything, fell into this trap of psychiatry.
And the result… Probably… Millions of people are KILLED and DISABLED by psychiatry every year around the world. If we count DEATHS and INJURIES between 1950 and 2025… this number could possibly mean over 1 billion people (perhaps between 1 and 4/5 billion) being ‘KILLED’ and ‘DISABLED’ (injured).
Unfortunately… It would be very difficult to know what these numbers really are because the ‘cover-up culture’ is so prevalent in mainstream medicine and mainstream psychiatry.
Thanks for the research Peter Gotzsche. Best regards..
With my best wishes.. 🙂 Y.E. Researcher blog writer (Blogger)
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Great comments, my friends. And thank you, as always, for your truth telling, Dr. Peter Gøtzsche.
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What do you think about the brain surgery performed on a woman in Colombia to cure depression?
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Thank you very much for your work and your perseverance. I have been suffering for a long time from the harm caused by antidepressants—and, due to the side effects, also from benzodiazepines. I’ve been off all medications for 11 years now, yet I still experience extreme withdrawal symptoms every day.
It is people like you who keep me going, who validate my experience. Your book Deadly Psychiatry and Organised Denial has accompanied me to many doctor’s appointments, and I’ve recommended it to many others.
Your work gives me hope that one day the truth will no longer be ignored.
(My story can be read here on this website under the title ‘Unprecendented suffering’)
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Talk therapy doesn’t work either. I wish people would stop promoting that dumb myth. The entire field has a fraudulent foundation and is utterly clueless.
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