The BMJ Refused to Publish Criticisms in Print of its Highly Misleading Suicide Prevention Articles

In a previous article, I described that the psychiatric leaders have denied for almost 40 years that antidepressants increase suicides and that leading medical journals, including the BMJ and The Lancet, have contributed to the systematic disinformation by publishing highly misleading articles about suicide prevention.¹

Here, I shall demonstrate that two recent BMJ articles about suicide prevention also misinformed their readers and that the BMJ refused to allow critics to publish their comments in the print journal.

In June 2026, the BMJ published a clinical update, “Assessment and management of suicidal ideation in adults,”² and an accompanying editorial,³ which I criticised in short e-letters on the BMJ website.^4,5

The update was about methods to reduce the risk of suicide.² It stated that the ”Evidence is insufficient for the efficacy of antidepressants for the treatment of suicidal ideation.” This is blatantly false. Antidepressants are very effective in increasing suicidality, including suicides.¹

The article mentioned clinical guidelines from the US Department of Veterans Affairs but did not say that the suicide rate has skyrocketed since 2006 when the Veterans Health Administration began implementing suicide prevention protocols that include routine screening, diagnosis, and treatment with antidepressants.^6,7 The suicide rate doubled among those who had been treated with drugs whereas it declined among untreated veterans.

The authors recommended identifying risk factors when taking a history but did not say that psychiatric drugs are risk factors and did not advise asking patients if any dose change was made recently, which increases the risk of drug-induced suicide because of akathisia.^1,8

They noted that cognitive behavioural therapy has a small to moderate effect. This is not true. It halves the risk of a new suicide attempt among those admitted to hospital after a suicide attempt,⁹ which is a large effect in high-risk patients.

Based on an uncontrolled study, the authors claimed that ECT is effective. Such evidence should not be used to advocate treatments, and ECT does not save lives, it takes lives. A systematic review found a death rate of about 1 per 1000.¹⁰

The editorial³ was also highly misleading.⁵ The authors wrote that ”Pharmacotherapy has an important role in treating underlying mental disorders that accentuate the risk of suicide and self harm. The issues underlying this are complex.”

When doctors face facts, they don’t like, they often deceive their readers by saying the issue is “complex.” The readers get the clear impression that drug therapy can prevent suicide. Otherwise, pharmacotherapy could not have an important role in treating disorders that increase the risk of suicide.

In an e-letter, Kristina A. Kaiser and Wendy B. Dolin from the MISSD foundation noted that akathisia is frequently overlooked and that they educate doctors about it.¹¹ They advised that suicide prevention efforts need to address medication-induced akathisia, which is characterised by intense inner restlessness, turmoil, agitation, and a compelling need to move that increases the risk of violence and suicide. These symptoms often occur after medication initiation, dose changes, or withdrawal, which patients should therefore be warned and asked about. However, standard suicide assessments rarely include questions about medications even though this can make a life-or-death difference.

When they presented to the Royal College of Psychiatrists’ International Congress in 2019, several members remarked that they shouldn’t know more about this than they did. This reflected a troubling reality: Akathisia is inadequately covered in many training programmes and is often overlooked in the suicide prevention literature and in clinical practice.

Kim Witczak, former FDA consumer representative in the Psychopharmacologic Drugs Advisory Committee, wrote in an e-letter that, as the widow of a healthy 37-year-old man who died by suicide five weeks after being prescribed sertraline (Zoloft, from Pfizer) for insomnia, she was struck by a notable omission from the suicide prevention review: the role of drug-induced effects.¹²

She described that her husband suffered terribly from akathisia before he took his own life and that his symptoms were not recognised as a potential adverse drug reaction but was interpreted as something that would improve if treatment continued. She told me that he was having terrifying nightmares that scared him and that she learned later that he had said to his mother that he was afraid of hurting Kim.

Following his death, litigation against Pfizer uncovered internal company documents that discussed antidepressant-induced suicidality and akathisia.

Retired NHS psychiatrist Peter Scott-Gordon wrote in an e-letter that he had personally experienced akathisia and suicidal ideation as a direct consequence of trying to come of an SSRI he took for anxiety and that people contacted him on a regular basis to share similar experiences, several of whom later took their own lives.¹³

He was concerned that the two BMJ papers did not include any consideration of drug-associated akathisia and iatrogenic suicidality and that when akathisia is mentioned in the BMJ, “it is almost exclusively in the rapid responses as written by patient advocates, survivors, and grieving relatives rather than appearing anywhere else in the journal” (rapid responses are e-letters on the website; they do not appear in the print journal).

Peter noted that the Royal College of Psychiatrists in its 2020 clinical position statement, “CR229 Self-harm and suicide in adults,” makes no mention of akathisia as a risk factor for suicide. His experience was that general practitioners had been told that suicidal ideation or physical agitation is a “worsening of the patient’s underlying psychiatric illness.”

He also mentioned that the UK National Suicide Prevention Strategy has failed to consider iatrogenic (caused by physicians) risk factors. He encouraged the BMJ to promote clinical training that includes routine consideration of such risk factors.

We see this omission in other countries, too.^14-16 And the little information you can find about akathisia in psychiatric textbooks is also mostly misleading.¹⁷ Psychiatrists generally interpret restless behaviour as agitated depression and a sign that the patient needs a higher dose of the drug, which aggravates the situation.

One textbook noted that akathisia can be seen at the start of treatment, which is highly misleading as it can occur at any time, particularly after dose changes.

The information about withdrawal symptoms varied in the textbooks but the most serious harms, akathisia, increased risk of suicide and violence, and abstinence depressions, which are not true depressions but drug harm,¹⁸ were absent.

In one textbook, a section about “The violent and aggressive patient” mentioned some drugs that can cause restlessness and aggression, which included benzodiazepines and amphetamine. It is inexcusable that the authors did not mention depression pills, methylphenidate and psychosis pills, and said nothing about akathisia.

Censorship at the BMJ

On behalf of all authors, Rosiel Elwyn replied to our criticisms on the BMJ website.¹⁹ As the reply was seriously misleading, I sent another e-letter explaining what was wrong.

I am convinced the BMJ didn’t want to publish it. My rapid responses have always come up quickly, in 1-2 days, unless the BMJ perceives some problem, e.g. a legal issue. My first two e-letters^4,5 were published immediately, but as I did not hear anything from the editor of e-letters, Sharon Davis, about any issues, I had no doubt what their intention was.

I uploaded the e-letter on BMJ’s website on 4 August. Six days later, I asked Davis, copying the other authors of rapid responses, why it had not come up, and if it would come up, adding that we all found my response very important:

“I ask not only on our behalf but on behalf of all the thousands of relatives who lost a loved one to suicide caused by an antidepressant and who were not duly warned about this terrible harm, just like the suicide prevention article in the BMJ did not warn about it. Moreover, Elwyn’s reply that I comment on now is also seriously misleading, as I explain.

I also kindly ask the BMJ once more to consider, in the public interest, if our rapid responses should not be published in the print journal, which we believe they should so that they can become widely known and entered in PubMed so that readers who want to find out if antidepressants can cause suicide can find them.”

Wendy Dolin wrote back, copying the BMJ: “Thanks for this fight. Unthinkable.” Wendy lost her husband Stewart after 36 years of marriage.²⁰ In the summer of 2010, he developed some anxiety regarding work and was prescribed paroxetine. Within days, his anxiety became worse, he felt restless, and had trouble sleeping. Six days after beginning the medication, Stewart left his office and walked to a nearby train platform. A registered nurse later reported seeing Stewart pacing back and forth and looking very agitated. As a train approached, Stewart took his own life. This happy, funny, loving, wealthy, dedicated husband and father who loved life left no note and there was no logical reason why he would suddenly want to end it all. The package insert for paroxetine did not list suicidal behaviour as a potential harm for men of Stewart’s age. Wendy didn’t know it then, but Stewart was suffering from akathisia.

As Davis did not reply, I wrote again, on 16 August, copying the editor-in-chief, Kamran Abbasi, noting that we find it appalling that:

– the BMJ refuses to publish my highly relevant rapid response to the authors’ misleading reply.

– the BMJ refuses to publish anything in the print issue about its highly misleading guidance article about suicide prevention that does not mention the role of antidepressants (they double suicides in adults, which has been documented in the placebo-controlled trials in FDA’s possession²¹).

– the BMJ because of its actions appears to be too close to the drug industry. When I was expelled from the Cochrane Collaboration in 2018, which I cofounded in 1993, after a horrific show trial I have written two books about and which we have made a documentary about, which will have world premiere in Lillehammer in September (Silence of the Truth: When Health Becomes Big Business and People Die²²), the then editor-in-chief Fiona Godlee wrote that Cochrane should be committed to holding industry and academia to account, and that my expulsion from Cochrane reflected “a deep seated difference of opinion about how close to industry is too close.”²³ Our film title is appropriate for the way the BMJ has handled the rapid responses. BMJ’s passivity contributes to future suicides that could have been prevented. The BMJ no longer holds industry and academia to account and people die.

The next day, Davis told me she was sorry for the continuing delay in posting my response, but that she needed to discuss it with colleagues.

Eight days later, I wrote to the editors again:

I uploaded my second, highly relevant rapid response on 4 August, three weeks ago, attached again here, and was told 8 days ago that I would hear from Sharon when she had discussed it with colleagues.

Why is this necessary? My comment is straightforward and there are no legal issues. I criticise the BMJ for being unwilling to publish the critics’ rapid responses in the print journal, to help prevent suicides. This is very sad, but that’s the position you have adopted.

If I have not heard from you during this week, I shall conclude that the BMJ is unwilling to publish my rapid response, which I consider a terrible act of censorship and self-protection that should not occur in a medical journal.

The BMJ posted my response the next day, 26 August. Even though journals always distinguish between date of submission and date of publication, they falsely dated it 4 August, perhaps to hide their embarrassment. Here it is:²⁴

Authors’ reply about preventing suicide still ignores the elephant in the room

On behalf of the authors, Rosiel Elwyn replied to some of the criticism of their article about suicide prevention (1). Elwyn thanked the authors of the e-letters except me and avoided responding to my criticism (2).

Elwyn claimed that “Unfortunately, there is a significant data gap on meta-analytic and systematic review-level evidence for medication-induced suicidal ideation.” This is a strawman because there are enough data on what really matters, suicide and suicide attempts, and in their article, Elwyn et al. mentioned that suicidal ideation can be about “planning suicide with high intent.”

Elwyn acknowledged that antidepressant drugs can cause akathisia but downplayed this to the extreme: “Initiating pharmacotherapy at high-therapeutic doses may increase risk of akathisia and/or suicidal ideation.” Antidepressants can cause akathisia at normal or even very low doses, e.g. when tapering to mitigate withdrawal symptoms (3), and numerous studies and observations have shown it is a very strong risk factor, not just for suicidal ideation, but for suicide and violence against others (4). Already in 1998, Pfizer scientist Roger M. Lane described akathisia as a drug-induced condition where patients may feel that “death is a welcome result” (5).

I told the e-letters editor, Sharon Davis, and the editor-in-chief, Kamran Abbasi, that the issue is extremely important and asked if the BMJ planned to publish some of the e-letters in the print journal and would invite submission of a critical article about the role of antidepressants in suicide prevention.

Davis said that the first step in selecting correspondence was to seek an authors’ reply to the responses. She did not respond to my question about inviting a critical article about suicide prevention.

As the critics of the suicide prevention article have not been invited to publish comments in the print journal, it seems to me that the BMJ does not want to provide honest information to their readers about the role of antidepressants in causing suicide. This is appalling.

E-letters on journal websites are not indexed on PubMed and they are therefore virtually unknown to the scientific community.

It is convenient for medical journals to appear forthcoming by publishing e-letters while they protect their reputation and the false narratives by avoiding publishing letters in print that challenge their editorial decisions.

1 Elwyn R. Medication-induced akathisia and suicidal ideation. BMJ 2026;July 22.

2 Gøtzsche PC. Suicide prevention article ignores the elephant in the room. BMJ 2026;June 18.

3 Horowitz MA, Taylor D. Tapering of SSRI treatment to mitigate withdrawal symptoms. Lancet Psychiatry 2019;6:538-46.

4 Healy D. Let them eat Prozac. New York: New York University Press; 2004.

5 Lane RM. SSRI-induced extrapyramidal side-effects and akathisia: implications for treatment. J Psychopharmacol 1998;12:192-214.

Protecting the false narrative

If the BMJ had been a decent journal, they would have replied that they of course would publish our letters in print, and they would also have invited an honest article about suicide prevention.

What is the purpose of medical journals? If you ask Artificial Intelligence, you may be told that they exist to communicate, validate, and preserve medical knowledge so that science can advance and patient care can improve.

This utopian view is very far from reality. Medical publishing is not about fostering illuminating scientific debate and saving lives; it is about earning money, saving prestige and avoiding upsetting the drug industry, which is important for the revenue for virtually all medical journals.²⁵ The ubiquitous censorship, where journals protect the interests of the elite and their friends, is why some of us no longer want to publish in medical journals.²⁶

In psychiatry, it is particularly bad. It is close to impossible to publish substantial criticism of psychiatry, psychiatric drugs, or psychiatric research or guidance in mainstream psychiatric journals, even just in a letter to the editor. Believe me, I have tried many times and so have many of my colleagues.²⁷ As an example, none of my highly relevant e-letters on the BMJ website from 2023 till today^4,5,28-30 about antidepressants have made it to the journal. They have telling titles about what was wrong with the articles I criticised:

• Suicide prevention article ignores the elephant in the room⁴
• The issues about psychiatric drugs and suicide are not ”complex”⁵
• The overprescribing of psychiatric drugs is real and it is harmful²⁸
• Antidepressants do not work for very severe depression either²⁹
• Depression drugs have been shown to double the risk of suicide in young people and should not be used.³⁰

A particularly disgusting way of self-protection is to refuse to retract fraudulent research or even just to publish a comment pointing this out. In one such case, JAMA Psychiatry refused to do anything³¹ even though two suicide attempts in children on fluoxetine disappeared before publication.³² I had asked 10 people, who lost a child or spouse to suicide as a direct consequence of being prescribed an antidepressant drug for a non-psychiatric condition without knowing that these drugs can cause suicide, to be co-signatories, but to no avail.

Anette Flanagin, Executive Managing Editor, Vice President, Editorial Operations JAMA and JAMA Network, replied: “We shared your letter with the author of the study published in Archives of General Psychiatry and he does not identify any new concerns. Similarly, we do not find new evidence in support of your request to retract this article.”³¹

Statistician Robert Gibbons has published fraudulent research linking the black box warning and reduced usage of antidepressants to an increase in suicides.⁸ When Mickey Nardo detailed the tricks Gibbons had employed in two papers in Archives of General Psychiatry, currently called JAMA Psychiatry, which included inappropriate data selection, opaque methodology, obvious arithmetic errors, and deceitful presentation, in a letter to the editor, the journal refused to publish it in its print edition.³³ Gibbons has served as an expert witness for Wyeth and Pfizer in cases related to antidepressants and suicide.³³

What should be done?

Imagine if a cardiologist said to a patient: “You are having a heart attack but we have a good drug that will double your risk of dying.”

If you think that would be crazy, you should also think psychiatrists and other doctors are crazy when they prescribe, or recommend in their guidelines, depression drugs to suicidal patients claiming they protect against suicide. I recently asked if psychiatrists are more mad than their patients and replied in the affirmative.³⁴

I call on everyone who has read my article to do what they can to help stopping the lethal madness and the atrocious lies about antidepressants protecting against suicide that we see everywhere, even in our most prestigious medical journals.^1,14

I consider it a crime against humanity to continue ignoring the serious harms of psychiatric drugs.¹⁵

Journal editors should change their practices profoundly. They should welcome academic debate instead of censoring it and they should let the authors have their say even when they disagree. I have described a grotesque example where my “Personal Opinion” in the BMJ ended as being the BMJ’s opinion and where the editor enforced highly biased wording that favoured the drug industry in a manner that went directly against the evidence.²⁶

I also mentioned how the editor-in-chief of the New England Journal of Medicine, Jeffrey M. Drazen, interfered inappropriately with our authors’ reply after we had published an article there. It was not our reply, but Drazen’s, and he wanted to support the drug industry.

Censorship is the worst enemy science has. And it is everywhere in medical publishing. Previous editor-in-chief of the BMJ, Richard Smith, wrote a whole book about it³⁵ and the article, “Medical journals are an extension of the marketing arm of pharmaceutical companies.”³⁶ In 2014, I published an article with him, “Should journals stop publishing research funded by the drug industry?”³⁷

The BMJ seems to have forgotten its legacy. It is appalling that the BMJ did not allow us to correct the seriously misleading guidance article about preventing suicides. People who subscribe to the print journal will not know that the advice was lethally misleading.

It is time to stop pulling any punches: The BMJ has blood on its hands, as it willingly propagates disinformation about suicides and antidepressants, and refuses to correct it, which it has done before and which the The Lancet also routinely does.¹⁴

So-called suicide experts invariably recommend antidepressants.¹⁴ It cannot be worse than this, but the BMJ won’t help. They are not even interested in inviting an honest article about these life-and-death issues.

References

1 Gøtzsche PC. Antidepressants are major drivers of suicides. But authors of suicide prevention articles ignore this. Mad in America 2026 (in press)

2 Stapper N, Elwyn R, Kepecs D, et al. Clinical updates: Assessment and management of suicidal ideation in adults. BMJ 2026;393:e086834.

3 Tyrrell EG, Morriss R, Vijaykumar L, Mughal F. Strengthening the UK primary healthcare response to suicidal ideation. BMJ 2026;393:e959881.

4 Gøtzsche PC. Suicide prevention article ignores the elephant in the room. BMJ 2026;June 18.

5 Gøtzsche PC. The issues about psychiatric drugs and suicide are not ”complex.” BMJ 2026;June 20.

6 Whitaker R, Blumke D. Screening + Drug Treatment = Increase in Veteran Suicides. Mad in America 2019;Nov 10.

7 Gøtzsche PC. Killing US war veterans with antidepressants. Gøtzsche’s Perspective 2026;May 2.

8 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

9 Gøtzsche PC, Gøtzsche PK. Cognitive behavioural therapy halves the risk of repeated suicide attempts: systematic review. J R Soc Med 2017;110:404-10.

10 Read J, Bentall R. The effectiveness of electroconvulsive therapy: a literature review. Epidemiol Psichiatr Soc 2010 Oct-Dec;19:333-47.

11 Kaiser KA, Dolin WB. Medication-induced akathisia: An overlooked contributor to suicide risk and iatrogenic harm. BMJ 2026;June10.

12 Witczak K. The missing question in suicide assessment. BMJ 2026;June19.

13 Scott-Gordon P. Re: Clinical updates: Assessment and management of suicidal ideation in adults. BMJ 2026;June 12.

14 Gøtzsche PC. So-called suicide experts recommend antidepressants, which increase suicides. Mad in America 2024;Oct 24.

15 Gøtzsche PC. Is psychiatry a crime against humanity? Copenhagen: Institute for Scientific Freedom 2024 (freely available).

16 Hjelmeland H, Jaworski K, Knizek BL, Ian M. Problematic advice from suicide prevention experts. Ethical Human Psychology and Psychiatry 2018;20:79-85.

17 Gøtzsche PC. Critical psychiatry textbook. Copenhagen: Institute for Scientific Freedom; 2022 (freely available).

18 Gøtzsche PC. Exposing the lie that antidepressant withdrawal symptoms are mild and short-lived. Brownstone Journal 2025;July 25.

19 Elwyn R. Medication-induced akathisia and suicidal ideation. BMJ 2026;July 22.

20 Gøtzsche PC. Case stories of suicides caused by antidepressants: Stewart Dolin. Institute for Scientific Freedom 2025;May 19.

21 Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: a re-analysis of the FDA database. Psychother Psychosom 2019;88:247-8 and Hengartner MP, Plöderl M. Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s Re-Analysis.” Psychother Psychosom 2019;88:373-4.

22 Filmvisning – om forskningens redelighet. Silence of the Truth: When Health Becomes Big Business and People Die. Documentary film by Janus Bang and Peter C. Gøtzsche. Inland University annual research days, Lillehammer, Norway 2026;Sept 23.

23 Godlee F. Reinvigorating Cochrane. BMJ 2018;362:k3966.

24 Gøtzsche PC. Authors’ reply about preventing suicide still ignores the elephant in the room. BMJ 2026;Aug 4.

25 Lundh A, Barbateskovic M, Hrobjartsson A, Gøtzsche PC. Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue – cohort study. PLoS Med 2010;7:e1000354.

26 Gøtzsche PC. Why some of us no longer want to publish in prestigious medical journals. Institute for Scientific Freedom 2023; Nov 14.

27 Gøtzsche PC. Whistleblower in healthcare (autobiography). Copenhagen: Institute for Scientific Freedom; 2025 (freely available).

28 Gøtzsche PC. The overprescribing of psychiatric drugs is real and it is harmful. BMJ 2026;May 10.

29 Gøtzsche PC. Antidepressants do not work for very severe depression either. BMJ 2023; Dec 5.

30 Gøtzsche PC. Depression drugs have been shown to double the risk of suicide in young people and should not be used. BMJ 2023; April 26.

31 Gøtzsche PC. Medical journals refuse to retract fraudulent trial reports that omitted suicidal events in children. Mad in America 2024;Mar 18.

32 Gøtzsche PC, Healy D. Restoring the two pivotal fluoxetine trials in children and adolescents with depression. Int J Risk Saf Med 2022;33:385-408. Can be accessed for free here.

33 Whitaker R. Yet another claim about the benefits of antidepressants bites the dust. Former FDA officials write that claims that the black warning led to an increase in youth suicides are “factually inaccurate in ways that are directly verifiable.” Mad in America 2026;July 16.

34 Gøtzsche PC. Are psychiatrists more mad than their patients? Mad in America 2025;May 6.

35 Smith R. The trouble with medical journals. London: Royal Society of Medicine; 2006.

36 Smith R. Medical journals are an extension of the marketing arm of pharmaceutical companies. PLoS Med 2005;2:e138.

37 Smith R, Gøtzsche PC. Should journals stop publishing research funded by the drug industry? BMJ 2014;348:g171.