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In his latest paper, Martin Harrow focuses psychiatry's attention on a very specific question: Do antipsychotic drugs provide a long-term benefit as a treatment for psychotic symptoms? His findings are consistent with a larger body of evidence that all point to the same conclusion, which is that antipsychotics fail that efficacy test. And thus, I think it is fair to say that on this issue, the Fat Lady Has Sung, Psychiatry needs to rethink its use of these drugs.

Mahatma Gandhi said, “First they ignore you, then they laugh at you, then they fight you, then you win.” With Pennsylvania Republican Representative Tim Murphy currently trying to push his Murphy Bill (HR 3717) through Congress, the battle is clearly on. And now, we are in the fight of our lives.

Martin Harrow along with his colleagues T.H. Jobe and R. N. Faull has published another paper on the long term outcome of people who experienced a psychotic episode. Funded by a grant from the Foundation for Excellence in Mental Health Care, this paper adds to our knowledge of an extremely important and valuable study.

In my last post here I gave a detailed analysis of the Human Rights Committee's recommendation to the United States to "generally" prohibit nonconsensual psychiatric interventions. I might not have been sufficiently clear about how I see the international human rights standards and the value of standards that we don't agree with but that are higher than existing U.S. law and practice.

The Human Rights Committee, a UN committee of experts that monitors the International Covenant on Civil and Political Rights, has issued a recommendation that the United States “generally” prohibit non-consensual psychiatric treatment, while going on to set out criteria for when “it may be applied, if at all.” It did not meet our expectations but marks progress. Keep our eyes on the prize: Use the recommendation to argue against any backsliding initiatives such as the Murphy Bill and the federal funding for outpatient commitment that has just passed the House in a bill on Medicare.

An important new research paper was published this week on the topic of antidepressant use during pregnancy and preterm birth.  The issue is a crucial one as preterm birth (i.e. birth at less than 37 weeks gestational age) is one of the most challenging problems facing the obstetrical community today.  Rates of preterm birth have been increasing over the past two decades.  Babies born early have increased risks of morbidity and mortality.  At the same time, rates of antidepressant use during pregnancy have increased dramatically.

A recent paper argues that prescribing antidepressants shortly after the death of a loved one is problematic . . . and a few days later, a Harvard academic publicly suggests prescribing antidepressants FOR bereavement. Wait, what?

I recently read an article by Fredric Neuman, MD, titled The Use of the Minor Tranquilizers: Xanax, Ativan, Klonopin, and Valium.  Dr. Neuman opens by telling us that benzodiazepines are "Very commonly prescribed for any sort of discomfort . . . They are called anxiolytics, and they are prescribed for any level of anxiety and more or less to anyone who asks for them." Dr. Neuman has been working at the Anxiety and Phobia Center for 41 years, first as Associate Director and then as Director. So when he says that benzos are routinely given to "anyone who asks for them," it's probably safe to say that he's being accurate.

What do you do when the media reports stories of children who have killed themselves on SSRIs? Position the stories of these children, not the drugs they were taking, as a suicide risk. Warn that more children will die if mouthy parents are allowed to speak and upstart journalists are allowed to report. And then position psychiatrists as the only people who can talk about suicide without producing an epidemic of self inflicted deaths.

I’ve come to understand that a single-minded focus on either therapy or medication can do great, if unintended, harm. I’m sharing this brief history of my journey, with both my good and bad decisions, to illustrate the importance of conscious care, and of maintaining the ability to change course.

People, in general, are afraid when other people act with hostility. This is a natural human instinct, of course. However, meeting people in crisis by returning fear and violence will often backfire. Finding a way to connect can instead be healing for everyone involved.

When I started working in the NHS in Britain I pretty much accepted the mainstream view – that psychiatric drugs work, that the categories of mental disorder have been established via solid scientific research, and that we are now on the cusp of understanding the biology of mental illness. I was wrong.

Dr Paul Offit, chief of the Division of Infectious Diseases and Director of the Vaccine Education Center at Children’s Hospital in Philadelphia, recently published a book called: “Killing Us Softly: The sense and nonsense of alternative medicine.” It also goes under the title: “Do You Believe in Magic?: The Sense and Nonsense of Alternative Medicine” The book presents some evidence on alternative medicines like homeopathy, Chinese herbs, chiropractic adjustments and, of greatest interest to us, the evidence for and against nutrient supplements for the treatment of illness.

On March 5, Bruce Levine, PhD, published an interesting article on Mad in America  titled Psychiatry Now Admits It's Been Wrong in Big Ways – But Can It Change? Bruce had interviewed Robert Whitaker, and notes that Robert, in his book Mad in America, had challenged some fundamental tenets of psychiatry, including the validity of its "diagnoses" and the efficacy (especially the long-term efficacy) of its treatments. Bruce reminds us that Robert initially incurred a good deal of psychiatric wrath in this regard, but also points out that some members of the psychiatric establishment are beginning to express a measure of agreement with these deviations from long-held psychiatric orthodoxy.

What is informed consent? Informed consent obviously means if you are being given drugs you should know the common and potential adverse affects, drug interactions, risk of dependency and addiction, and counter-indications with other substances, health conditions or health concerns. This is the baseline of informed consent (which many people don't receive) but there is an incredible amount more that is included in what you deserve to know about any drug you are prescribed or medical system you are advised to subscribe to.

One of the roadblocks to recovery for those who suffer from depression is our culture's tendency to stigmatize depression and other mental health disorders. After my first hospitalization, I remember the dilemma I faced in trying to explain my three-day absence to my employer. If I told the truth—that I was being treated for anxiety and depression—I stood a good chance of losing my job. Instead, I reported that I had been treated for insomnia at a sleep clinic. In another instance, a client of mine who worked as a nurse was petrified of telling her colleagues that she dealt with depression, but when she shared her diagnosis of cancer, they showered her with with love and support.

I've been on hiatus for a few months now, and I decided that an informal entry would be most fitting at this time. I have had one question on my mind lately: what would motivate Psychiatry to drastically change its mission and practices in a way that is most consistent with contemporary evidence and moral responsibility?

The first time I tried to kill myself, I was 14. I won’t go into the indignity of being involuntarily locked up, time after time, until I satisfactorily convinced the staff that I wouldn’t harm myself or attempt suicide again. (I was lying.) The system taught me to lie, to hide my suicidal feelings in order to escape yet another round of dehumanizing lock-ups and “treatments.”

Philip Seymour Hoffman died only 5 weeks ago. I was disappointed by the immediate zoom-in on Hoffman’s heroin addiction and the immediate and zealous search for villains; for the evil dealer. The toxicology report completed after his death led the New York City medical examiner to conclude that he had been “killed by a poisonous mix of drugs that included … heroin … cocaine, amphetamines and sedatives.” Yet, no outcry against Big Pharma for producing these drugs – the amphetamines, sedatives and the oxycodone – in the first place. Nor against the FDA for allowing them willy-nilly in the marketplace with little regulation. Nor against the GP’s who dispense these drugs like M&Ms.

The recent publicity surrounding the Justina Pelletier case has focused attention, not only on the spurious and arbitrary nature of psychiatric diagnoses, but also on the legitimacy and appropriateness of mental health commitments. It is being widely asserted that these archaic statutes are fundamentally incompatible with current civil rights standards, and the question "should mental health commitments be abolished?" is being raised in a variety of contexts.

This Wednesday, March 19th I will be speaking with the wonderful folks at Rethinking Psychiatry in Portland Oregon. These amazing individuals are working on reforming the mental health system and creating practical alternatives such as a Soteria-based housing model in the community. As I look at the present state of how we help people in severe emotional crisis I see enormous problems from beginning to end. I want to outline some of those main problems and then look at some ways we could work to reform them.

UN Human Rights Committee member Ms. Zonke Majodina said on Friday during the Committee's review of the United States: "I’m wondering whether any states have considered the ban which has been recommended by the Special Rapporteur on Torture made February last year, available on the UN website of documents. So given that it is really at state level that there is no compliance with the requirement to prohibit coercive treatments especially in mental health settings, I think the matter cannot just be left, there should be some form of good faith undertakings by federal government that these recommendations by UN bodies is taken seriously also at state level."

Under DSM-IV, a "diagnosis" of somatization disorder entailed a history of physical symptoms for which, despite thorough medical evaluation, no satisfactory physical etiology could be established. In DSM-5, this "diagnosis" was replaced by somatic symptom disorder. This is essentially similar to DSM-IV's somatization disorder – with one critical difference. The newer "diagnosis" can be assigned even if there is an identifiable physical illness.

When one is coming off of psychiatric pharmaceuticals, it's common to experience withdrawal induced anxiety, panic and psychosis. Here are some tips to help calm your body.

In the past decade, much concern has been raised about the increasing, excessive and inappropriate use of off-label psychiatric medications for children. In addition, the use of medication cocktails (polypharmacy) has become increasing common in child psychiatry. Several medication-related deaths have been reported in the past ten years. In 2006, the Food and Drug administration (FDA) received reports of at least 29 children dying and at least 165 more suffering serious side effects in which an antipsychotic was listed as the “primary suspect.” That was a substantial jump from 2000, when there were at least 10 deaths and 85 serious side effects among children linked to the drugs.