Wednesday, November 14, 2018

Comments by ConcernedCarer

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  • Sounds a bit like a blind alley but if they can screen people and do an RCT the world could be their oyster. But it sounds pretty improbable.

    Pschiatrists really do believe that “the right drug suits the right person” when it looks more like some people are just big placebo responders or perhaps should not have been in the study at all. There is no evidence for the subgroup hypothesis, because if there were, you could test that subgroup.

  • The big worry with kids is AD induced suicide. Lots of controversy around data, but there is no doubt suicidality spikes on starting and stopping. The whole prescribing of ADs to kids is a scandal when we know they work even less well than in adults, if that were possible.

    My anecdotal research suggests informed consent is never followed.

    This study doesn’t really suggest fantastic solutions, people should do psychology and psychosocial stuff in any event.

    In the UK we need NICE to grow a pair, triple the tapering recommendations, and make smaller tablets available.

    To my knowledge , the smallest sertaline tablet in the UK is 50mg, which takes you from 75% inhibition to nothing at a stroke and will tip you into withdrawal for sure.

  • Thanks for this article, the language of mental health is pretty debilitating.

    Linda Quixote – CARE – nice one – I will commit that to memory!

    I find myself battling with vocabulary a lot. I DO find I use the word “in recovery” as an alternative to “mentally ill” which the system slugs people with.

    I struggle with an alternative to “mental disorder” or “mental illness” and I end just talk about “problems” or “distress”.

    People going through the system become very bitter about the language used against them. It seems to me that to get to a better place it is helpful if you genuinely and evidentially believe that you are OK, you are not a freak or an alien – that there is nothing biologically wrong with you, or at the very least nothing you can’t deal with. I do. Psychiatrists are on a mission to persuade you otherwise, and I will have no truck with it. Because, EVEN if it were true that you were “biochemically disordered”, whats the point in going on about it, if you haven’t a clue about what “it” is?

    I’m not religious but we all know our bible stories. I wonder, if Jesus, or any other prophet for that matter, had been a psychiatrist (a psychotic one, but lets gloss over that), would he go round slapping labels on people instead of non-judgementally helping them make themselves better people?

  • Love it Auntie, I like your description of the tactics. Conventional Psychiatry’s use of language is hilarious if it wasn’t so dangerous.

    At the risk of a double-decker broadside from the hard-liners here, I would say that I’m pleased that he is speaking out, even though he has books to sell. You have to admit, he makes more sense than a certain Italian psychiatrist from Kings College.

    And he gives you specific issues to critique as Phil and you have done. For me, I hook onto that line “medications are absolutely essential for severe depression”, as being something to be specifically examined.

    I think that for people critical of psychiatry, his writings are helpful.

    CC tacking to port and battening hatches.

  • It was so liberating to be discharged from acute services here in the UK. No more sleepless nights before being yanked in for massive meetings with the psychiatrist, full of bogus claims and who would never take no for an answer. Lol recall that fantastic quote “we don’t have to agree about everything”. Threats of imprisonment, contentious accusations of disordered thoughts and family problems. Huge CPA meetings about nothing because He had decided what “he was going to do”. Magic day when we left that behind.

  • I think 2 things that could and should happen are:
    1. Stop people being forced onto medication. Even in a voluntary situation, the elephant in the room is always “better do as the psychiatrist says or else”. Take that legal right away in all but the most extreme and temporary circumstances.
    2. Stop people bring bullshitted onto medication. Patient leaflets should be mandatory and enforced days PRIOR to going on medication with the clear right of refusal evidenced by written consent for all neuroleptics with extra provisos for off label. For drugs with an effect size less than , say, 0.5, or an NNT over 5, there should be a “Clinical Efficacy Warning”. If possible,there should be a way of giving people a better perspective of the harms in addition to those endless lists.

  • Fiachra: I’m interested in what you think about this idea that people tend to “relapse” when they stop the meds, and it’s just a question of how many. Do you think for example , the drugs led to “remission” of the problems you had, or did they just suppress a subset of the symptoms for a while, at the same time giving you some more.

    It used to really irk me when we were told that the drugs “got you better”, or even more ludicrous “got you back into life” or bizarrely “shifted these ideas” once you got to “therapeutic dose”. It all looks like a load of cods now.

    I can’t put my finger on what exactly the drugs do , but I don’t think they get you better , so I’m not sure it’s right to say that people relapse. I know this is an extreme view, basically saying that they are useless and just fool the doctors into thinking the person is “better” when in fact they are just coshed.

  • I must say I couldn’t really recognise Eleanor either, but who knows, she may have actually been like that. HBC’s Eleanor seemed quite hard to get close to, distant. I think I was expecting someone even more prickly, more tempestuous, more distraught, that we the audience could really feel for.

    I hope noone gets cross with me, and please note I do not believe in mental disease, just states of distress. But I expected Eleanor to be far less functional than she actually was. I’m not being patronising, I just think when you are dealing with issues that are depressing your mood and psychosis, plus being physically disabled by a drug thats also addling your brain, it is to be expected that you will act in a way that reflects the turmoil, despair, fatigue and discomfort you are in. At times it seemed that it was Eleanor who was the level headed one and it was the lawyer who was starting to lose it. However I think that was intentional and was meant to demonstrate Eleanors improving health as she reduced her dose.

  • I hate to say it, but I do wonder if the whole language of relapse is a mistake. It implies a deterioration after a period of improvement, or a return to a previous worse state – as judged by one person with a clear observational bias, the psychiatrist.

    The misnamed “anti-psychotics” are really broad spectrum brain suppressants, that, at the very best, suppress psychotic symptoms that may well return at a worse level upon discontinuation. Its worth noting that even this “beneficial” effect is really very weak in most of the drugs. In the process they damage your body, make you dopey and apathetic, and, I would argue, depressed, fatalistic, defeated and psychologically dependent. They therefore put you in an uncomfortable and unsustainable limbo, not a relapsed state of good health.

    Relapse implies they got better. They didn’t. The drugs just stuck a lid on things and I think recovery can only begin when you start to come off them.

  • Yes I think those are good points. The film didn’t move me as much as the trailer did actually. I was probably hoping for too much, but nonetheless I have to give it 2 cheers. A great effort that clearly had very little money. I think Helena Bonham-Carter, despite her controversial “right level of medication” remark, deserves enormous credit for helping this film happen and working so hard on her character. If it raises the issue of psychiatric abuse just a little then thats a step in the right direction.

    The technicalities of the law weren’t really made clear. It appears that California already had a law against forced treatment, but that the hospital were essentially breaking it. Their limp defence was, well, if we aren’t medicating to, erhem, help the patient, then we are in breach of the same law. The judgement is worth a read – some of the criticisms of medication are quite good actually, pointing to cognitive disablement and the full raft of life threatening side effects – this is 30 years ago.

    https://caselaw.findlaw.com/ca-court-of-appeal/1771297.html

    It made me think that even a story thats quite straightforward, that doesnt require a big cast or elaborate sets etc, can still be a problem for writers. There were lots of little issues that didnt get fleshed out enough, but I don’t want to be picky about a noble effort to portray a difficult subject.

  • I was just trying to fathom what this study was trying to say only last week, because its still used as a primary defence for antidepressants, so it was great to see that someone had managed to work it out.

    Cherry picking the mood item is a key tactic employed, along side the subset theory (some people have properties that make them benefit a lot – and presumably some people are the opposite and greatly harmed).

    Interestingly, the Cipriani review of Feb 2018 had an effect size of just 0.24 for citalopram on the 53 point Hamilton.

  • Incredibly moving, stopped me in my tracks. I think it should be an essential introduction for all budding mental health professionals. Lest they forget.

    Am I right in saying that, in the UK, we basically do not have even the right that Eleanor Riese achieved in California 31 years ago? Specifically, even if you “have capacity”, is it really the case that you cannot refuse treatment if you are sectioned?

  • I feel an incredible sadness about antipsychotics. Many of them are of marginal efficacy in RCTs, and the disabling effects are all too evident, people tolerating metabolic deterioration believing their abnormal flawed brains are only kept in check by a pill. I went in search of tapering guidelines from NICE, patient leaflets or RCPsych and found none. Please correct me if any exist.

    What there is, are studies showing that once you’ve been on them for a while your chances of staying alive or out of hospital are better if you stay on them. I doubt this, because how you fare must depend on how you are tapered and other support you receive, but there does least seem to be a red flag that the longer you are on them the more careful the taper needs to be.

    The same Finnish study I’m thinking of also would indicate that since the hospitalisation risk on discontinuation continues to rise on anti psychotics, it’s better to come off earlier rather than leave it too late.

    We really don’t know how badly these drugs damage people and cause dependence, whilst all the time stopping people functioning and amazingly actually shrinking their brains.

    This paper says that half the people didn’t even ask their doctor before stopping, presumably because they knew the answer – “don’t do it”. It’s a mess.

    I hope the UK parliamentary group on prescribed drug dependence has the time to look at antipsychotics as well, because although the numbers are smaller the disablement is huge.

  • Oldhead: for the record, I have never said the drugs work, psychiatry is in fact currently a health field that claims to make people better, and people that either choose or are forced to receive psychiatric treatment need a name and whilst “patient” isn’t the best i can’t think of a better one at this moment.

    Posters on here should really read what others say and stop assuming that everyone apart from them is a baddie. Most of us here are basically on the same side, even people I’ve sometimes disagreed with. There is a difference between critical psychiatry and anti psychiatry to be sure, but it’s a spectrum.

    Let’s move on and listen respectfully to the important views and insights everyone has to offer and not simply say “you are confused” – after all, we know that tactic all too well, don’t we?

  • I don’t see any evidence for a subset in severe, and why on earth that would mean there is a subset in mild as well escapes me. Its another hunch with no coherent mechanism of action.

    The bottom line is that we can’t find a clinically significant separation from placebo in anyone. These Star*D results suggest it’s even worse when used in real life. And we still don’t have a credible mechanism of action, do we? I mean, is there a coherent argument left supporting their usage?

    So, knowing what we know now, that Fluoxetine and Citalopram have effect sizes some 20% below what NICE at one stage considered clinically significant (0.30), and knowing the increased risk of suicidality, should they ever have been approved in the first place? Shouldn’t they be taken off NICE’s list of approved medications until someone somewhere produces credible evidence to support their use?

  • At the risk of getting a battering I will say that the talk of political ideology has no place in assessing the efficacy of antidepressants. We need approaches to “it” regardless of where you are on the political spectrum.

    I don’t think there is evidence for a subset we can identify for whom antidepressants “work”, so statements like “10 times too many” have no evidential underpinning.

    There are approaches that respect and empower the patient, like open dialogue and psycho social and recovery projects, but the current psychiatric profession has either turned away from these or shown luke-warm support and they would need to turn their training on its head to embrace them.

    Psychologists need a bigger role because they “get it” and psychiatrists need to lose some of their power because they have abused it. This can start by NHS psychologists undertaking to keep your conversations private and not just act as note-taker for the psychiatrist.

  • My understanding is that Dr Moncrieff does not point out that a small number benefit from the chemical in the drug, for the simple reason that she cannot find evidence to support this, and nor can the rest of us.

    I do not think that, as yet, there is such a thing as an antidepressant, but I am not shaming those who come to a different conclusion and take the drugs. Shame implies that they are doing something I consider morally wrong or stupid, or they have let themselves down and should know better. Far from it. They are told by experts like those whose names appear on the Science Media Centre that the drugs “work” and are “much better than placebo”. Their NHS psychiatrists say unblinkingly that the drugs reverse a chemical balance. I don’t blame them for trying anything that might make them feel better when they are in grave distress, nothing seems to help, and everyone around them tells them it will work. There is no shame in believing what experts tell you. We know where the real shame should lie.

    Why is the onus of proof always on those who believe antidepressants don’t work? I thought that you didn’t have a drug until you proved it worked, which the drug companies originally succeeded in doing, but now the results no longer seem to hold up. Where’s the evidence-based argument that they work? There must be some scientific justification, where is it? Do you have any reason to believe they might work? Is it the idea that efficacy must exist because there are some people whose response is on the right hand end of the of the bell curve? Because that applies equally to placebos and just isn’t science.

    You are saying we should use them out of a hunch they might work when the data is strongly suggesting the opposite. Thats rather odd, but amidst all the statistics, have we even got a credible drug mechanism or is that guesswork as well?

    Dr Moncrieff is highlighting an important paper that is reporting what was intended to be the primary outcome of an expensive study which for some reason was never reported. It is indeed dismal and researchers should be trying to figure why.

  • Its the process of deduction and honesty that matters to me. No-one can say that biochemical imbalances cause mental problems until evidence proves otherwise. And you can’t say a drug reverses an imbalance if it doesn’t or there isn’t an imbalance.

    Psychiatry has to learn to live with uncertainty and be able to hold several theories in mind as possible causes without being definitive.

    Jumping to conclusions has got psychiatry in the mess where its drugs are not effective and in a great many cases makes things worse. The lack of scientific rigour in some quarters has become laughable and that is terribly undermining for a profession that I still think we need.

  • @streetphoto: Well, OK, but please god lets hope psychiatrists don’t start running round with this notion, which is still just a theory.

    As a matter of interest, the main drug class that affects gaba is (gasp) benzos, is it not? I think Peter Goetsch said that short term crisis use of benzos has been undervalued. What do you think of that?

    With migraine, are you saying that Triptans are not as effective as we are led to believe?

  • @streetphoto, I hope the bunker is agreeable, I’m thinking of going down to mine when Storm Callum hits.

    Don’t you think the GABA theory should be put in perspective? It is a theory where there is some interesting research, stimulated by the increasing doubt over the dopamine theory. It is not yet a cause that has evidence to back it up. It may well go the way of the seratonin theory (always BS) or the dopamine theory (jumped the gun, it might be a pathway but probably not causal). But it might just turn up something, open mind and all that.

    So as yet there is no chemical pathology we can find and no brain disease we can identify, and psychiatrists, in the name of their own ethics, should stop telling their patients this until something is found where the weight of evidence is compelling. It does no good whatsoever because the patient feels broken, debilitated and then angry as he/she does their own research – the psychiatrist then loses all credibility and is exposed as a charlatan (strong word but strictly accurate).

    Jumping to conclusions is psychiatry’s biggest intellectual failing, ironic since this can be a failing in their patients – I’m sure you agree. I think you could even say that the GABA line of investigation is promising and might yet prove to be part of the puzzle, which is quite something in a research landscape littered with failure, but surely it is no more than that, don’t you think?

    A GABA drug supported by 2 flukey unblinded studies is just what we need to muddy the waters. Drugs to down-dopa, up gaba, up sera, up noreph, up adren all based on theories and giving rise to an chronic over-medicated mess. Already the research is massively complicated by universal overprescription of antipyschotics so you can’t work out what’s what.

    Off to bunker but have a bit of battery left on the laptop.

    Agreed that we do have alot in common, except you have a tin hat.

  • I’m really pleased you highlighted this paper, and I hope some more academics read and respond to it, because, if it’s right, it’s a bombshell. I say if it’s right because we are all wondering incredulously how the placebo in an RCT can massively outperform the drug in real life. I know it’s apples and oranges, but then we are saying RCTs of psychiatric drugs are so riddled with placebo effects we can’t use them for anything.

    We all understand how Irving Kirsch proved the drugs were basically useless as drugs but possibly useful as (rather damaging) placebos. Now it seems that in and of themselves they aren’t even much of a placebo. Even I’m having trouble believing it’s this bad.

  • Not sure if the bunker has WiFi but when you surface again…..

    “How do you know if you are low in the ions necessary to regulate the NMDA? well migraine/anxiety is a sure sign.”

    Isn’t that BS of the kind we are all railing against? Sorry if that seems strong, please prove me wrong!

    It’s an interesting theory streetphoto, alongside all the other chemical imbalance theories. But where’s the evidence it exists and causes mental “disorders”? Not in those references I don’t think .

  • @despondent: “extreme mental states are not solely psychological in origin.” That’s a interesting question. Have you any examples? I think that might be right, but I can’t actually think of any at the moment that aren’t psychological in their root cause. I think even enlightened biological psychiatrists are coming round to the idea that it doesn’t start with chemistry, I’m thinking of Sir Robin Murray. We can at least identify highly correlatable psychological factors, but there isn’t any other possible cause that has any evidence at all, is there?

    Oh, and Steve: in the UK , I don’t think the driver is money, I think it’s job security and toadying up to your professional leaders. You won’t get fired for doping someone so much they can’t function for years, but if you don’t drug I think that could cost you your job, I thought I saw an example of that .

  • People have been saying venlafaxine looks as if it is an opioid for a while , it’s good to have credible research into this area, with a firm recommendation to reconsider its use.

    Something else about venlafaxine. I trust I didn’t misread her study, but Carol Coupland at the university of Nottingham found in a large observational study that venlafaxine had over double the number of suicides than fluoxetine. There is a possible confounder in that it might be for more depressed patients, but she said it needed looking at.

  • Amen to that Steve.

    My experience is that the psychiatrist will try to lower your expectations and indoctrinate you with “it’s biological, it’s not curable as such , it’s treatable with chemical but you may never be fixed, it’s psychiatric not psychological, it’s an imbalance that only drugs can reverse”. These are the messages I got from the NHS and it’s shocking. I had to call time once saying we just don’t have time for dogma we have to work on getting better.

    When all hopelessness is being heaped on you, just believe in the power of human recovery. Believe in this person , they can and will do it if the people they trust don’t undermine them.

    For me, apart from deliberately undermining hope so as to engender dependence, psychiatry’s other biggest sin is to deny the evidence that there is no chemical pathology we can find, no brain disease we can identify, but are there certainly psychological causes for extreme mental distress.

  • Thanks for an clear summary and your own intelligent views.

    “I know people who appear to benefit from these drugs. However, I want to use them in a way that is most helpful and minimizes harm”

    I’m finding it hard to sympathise with this position. There is a presumption that they do good, its just a question of how much and at what cost. We don’t know what the drugs are doing (do we? Clozapine, Seroquel?), we would never dream of taking them ourselves, but we do it anyway, trusting what we see and that the orthodoxy must have some basis, and downplaying the lack of efficacy and dropout established in studies.

    What you might see is a reduction in voices, which may or may not be helpful. This reduction could be simple time remission in an episodic condition, observation bias, and is most certainly largely placebo effect, as hard as it is to admit that. And it’s not always the main problem is it? The problem might be depression and an unhelpful way of looking at the world, and a broad spectrum brain suppressant might make this worse.

    “To put this another way, only 33.1% of those in the studies were in remission.”

    They were only able to say this because the short study length meant they had to ignore the 6 month Andreasen time criterion. I think real remission is much lower.

  • This is interesting because I think these are reputable researchers.

    They say “For symptomatic remission, we used the definition proposed by Andreasen without employing the time criterion.” and this is a common assumption and for short 6-12 week trials – there is no other option really. But the time criterion of 6 months where symptom reduction of 50% or is achieved is there for good reason, since psychotic symptoms are episodic. To be honest, to only achieve 33% with that level of improvement over 4-6 weeks is rather dissapointing – you can be sure that the proportion that would stay in good shape for 6 months (true remission) would be much, much less.

    The other thing, as you point out, is the mean duration of “illness” of 13.6 years. What are we measuring here? Not people developing psychosis and getting better through antipsychotic drugs. There is no way this cohort would not be on antipsychotics anyway. I think what we are measuring is when they change the antipsychotic to the test drug. So, as you say, you have the efffects of chronic use, possible withdrawal etc. I find it hard to glean anything new here, since the effect sizes of many antipyschotics are rather small anyhow. But it is good that the question is being asked.

  • It’s OK, if you hang around in one part of the health service long enough you get moved on. I’m not sure you actually get a choice as to whether you have to see your psychiatrist in the NHS anyway.

    On the bright side, I don’t know if I’m imagining it, but I’ve found that if you challenge them with evidence, they do seem to give in more and more. But it still feels like that kind of relationship – they want to do something with you and if you don’t like it, you have to resist – and that feels like a real battle. I was in a meeting once with all the MH people and I heard the psych say to himself “ah, now I know what I am going to do”. That sums it up really.

  • The incredible thing was that I was having to negotiate with them to slow the whole thing down, they were in such a rush. And very insistent to review once off them because thats when you will be feeling so crap you will be needing, well, you’ve guessed it. I was made to feel wierd for just asking for a couple of weeks extra, OK I got one. Its very easy to cut the tablets. I still have no idea why they were in such a hurry. When in the immediate aftermath signs of unspecified ill health did start to emerge, out of the blue they started doing blood tests. My feeling is that they don’t know what they are doing, and I have some evidence for that in the non-guideline things they did.

  • I don’t think mainstream psychiatrists believe that withdrawal is anything other than a rare event.

    Only 6 months ago and in the UK I was involved with a taper from a near maximum dose of an off-label antidepressant in just 3 weeks. It was as much as I could do to negotiate 4. For this particular drug that meant going from 70% reuptake to zero overnight. No talk of withdrawal at all, just the possibility of “your depression coming back”, as if it ever went away.

  • I don’t disagree with any of that. To be honest, I don’t think we have any idea what blocking seratonin reuptake does, and certainly not a clue about the NRSA’s, NASSA’s, etc. Disabling part of your brain, well, anything can happen.

    But I do think its important to expose the very reason these drugs were ever approved: the question of efficacy. They are there, not because of a credible mechanism of action, but because RCT’s showed a statistical, although not meaningful, superiority over placebo. The fact is that the placebo effect and simple remission time have always been the predominant effects observed in the trials. So people did improve compared to baseline ie where they started, but it wasn’t really due to the drug. What we are seeing is that the closer they look at the effect size, the smaller it gets. What this paper shows is that something happens in antidepressant RCT’s to make drugs look better than they really are. In the UK, this finding should surely inform new NICE guidance on antidepressants.

  • Pauline and Kabbal, interesting points. From what I saw of the crisis team it was a box ticking exercise that was slow to react and aimed at protecting themselves, it wasn’t really equipped to deal with a crisis anyway.

    I have come to wonder if MH services are really on your side at all. They protect themselves at all costs and aim to eliminate risk by hospitalisation and attempt without much success to eliminate symptoms with “medication”, even if that stops you getting back on your feet.

    They would say that dead patients don’t recover, but you could also say drug-wrecked patients, life chances shot, debilitated by a diagnosis of some made-up chronic condition, will become more suicidal. And it is quite possible to commit suicide in hospital anyway. There must be another way.

    Looking at strategies is a worthwhile thing to do, certainly we need a bit more than deep breathing and elastic bands. I sometimes think we need a 24 hour psychology service, a kind of “para-psychologist”, who is confidential, non-judgemental and separated from psychiatry, but then I think, thats what a supportive family might sometimes be able to do.

  • I know I’ve posted this link to the Guardian article before, but it is quite mind-blowing. Data from a Freedom of Information request shows that a staggering 1 in 6 people in England were prescribed antidepressants in 2017.
    https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants

    The College of GPs and the RCPsych of course try to say how good it is that depression is being diagnosed and treated.

    One sixth of the population have clinical depression that requires chemical correction? Bonkers.

    Its not as if the drugs actually work anyway, but thats another story.

  • It looks to me like tranquilizers, or brain suppressants, which is what these drugs really are, can sometimes take the edge off psychotic symptoms. Sometimes. A close look at the RCTs proves they one or two of them, at best, do a little. But its at a huge cost in terms of physical health and overall cognition and dependency. At best they will kick the can down the road, but I think they run the risk of turning a crisis into a permanent disability.

    Their use is also accompanied by the unsubstantiated claim that the core problem is an imbalance causing psychosis causing low mood etc. I think it’s the other way around. Life events cause stress, internal conflict and low mood which spills over into psychosis. The difference between these 2 models is that one says , without evidence, that you are broken and all we can do is try and paper over the cracks, whilst the other says you have a psychological and situational challenge on your hands that you need help to overcome.

    So the long term studies, such as they are, support this assessment. You may numb people up sufficient to keep them out of hospital, whilst effectively terminating their ability to make their way in the world and reducing their ability to think themselves through their issues. And over time the drugs will sadly derange you even if you try to stop.

    The band aid will progessively cripple you – but mental health services have neglected other ways of helping with that stress.

  • Interesting paper, John. My reading of it is that there must have beeen a 9% reduction of offences on placebo compared to 35% on supplements, hence the 26% difference, over about 20 weeks in a smallish sample of 230. The study seemed to remain blinded. This was in 2002, and we could probably be smarter in the supplements we could use today. Could we have the latest “anti-criminaliser”? I wonder if this was ever acted upon.

    However, as I write this, I wonder if I am seducing myself with a chemical imbalance hypothesis!

  • This is really quite interesting. An honest placebo is as good as “proper” IBS drugs. What’s going on? It has to be the doctor relationship that is driving the healing effect, doesn’t it?

    In mental health, the psychiatrist has huge influence with the patient that could in the right context help people improve in and of itself. The shame is that they deal out damaging drugs at the same time, probably in part because they think the drugs placebo effect might help. Indeed it might, but increasingly people are wising up to the harms and the dishonesty, and this probably negates the curative value of this smoke and mirrors. If psychiatrists were more honest and open to suggestion beyond medication, they could achieve alot. But first they have to do no harm.

  • Sorry – just to correct myself, the RATE of new antidepressant users is falling. The total number of antidepressant users is still rising due to long term usage and the fact that there are still new users, even at a rate that is slowing down. You could say that the juggernaut is slowing down but it has not stopped or reversed yet.

    60% of users of antidepressants have in fact been on them a year or more, so it will be a while before we could see falls in the absolute level of antidepressants.

  • Slightly interesting recent take on this idea in the UK.

    The Guardian ran a story recently reporting that the rate of NEW ADULT users of antidepressants has fallen by something like 20-25% over the last 2 years, and suicide has fallen 8%. I don’t claim any association, but I think the reduction in new users indicates that the truth is coming out, and there has been no disastrous explosion in suicide. I wander what the RCPsych and others would say about that.
    https://www.theguardian.com/society/2018/aug/10/four-million-people-in-england-are-long-term-users-of-antidepressants

    On the other hand over the last 15 years there is been a 3 to 4 fold INCREASE in young people poisoning themeselves on antidepressants to the point that 10% of poisonings are from this source in England, more than opioids.

    I don’t normally think of antidepressants as the go-to suicide method, particularly since amitriptaline is not on the approved list. But from what I have read there are 2 increasingly popular drugs that are much more associated with suicide than the usual SSRIs: Mirtazapine and Venlafaxine. I am cross about this because we had Mirtazapine pushed at us very hard.
    https://www.theguardian.com/society/2018/sep/11/sharp-rise-in-young-people-overdosing-on-painkillers-and-antidepressants

    So in the UK/England,it seems that antidepressant prescribing is falling overall, with no visible deterioration in suicides. However, in young people, antidepressant poisoning has over time been rising markedly, and I do think they should look at the safety of the individual antidepressants they are prescribing. Apart from the obvious fact that they don’t work at all in young people, there are a couple of them that have an elevated suicide and poisoning risk.

  • Thanks for keeping the spotlight on this.

    Its is incredible the excuses the “experts” give for why, despite the evidence, AD’s work:

    (1) “Some people get better on AD’s” Don’t mention that they also do on placebo.
    (2) “Clinical Experience”. Yes that gave us insulin coma therapy.
    (3) “The RCT’s are flawed”. Well, yes, they did not disclose all the negative stuff that they should have.
    (4) “Placebos are getting too good”. For heavens sake. A true placebo would be an active placebo with similar side effects like dry mouth – these studies apparently show AD’s to be even worse.
    (5) “all the studies show they prevent suicides”. To my knowledge, there aren’t any convincing studies that show this. Amongst under-18’s, we have rising suicide and rising AD rates.
    (6) “they aren’t perfect, but they are getting better”. Top of the league in the Cipriani study (probably due to unblinding and sedation) by a distance was amytriptaline, discovered in 1960 and not reccomended because it is potentially lethal.
    (7) “the placebo effect alone is worth having”. But it is not ethical to prescribe a drug which has no therapeutic effect and will quite likely damage you.

    The story is out, it really is. I’m just a carer, nothing special, and I know others in my position who know the full story now and will never be fooled.

  • Ah yes, good point, that is the other possibility – that having “suboptimal” vitamin D (<20) is typical of the population at large. I couldn't find your 75% stat, but I did find a paper that talked of an average of 41% have less than 20 ng/ml on the whole and 73% less than 20 ng/ml in winter (in northern latitudes). This paper talks of 80% less than 20 ng/ml in FEP so, yes, it does look like its elevated. This could be due to the antipsychotic or actually could be due even be partially due to anxiety and isolation.

  • They don’t seem to say if the FEP people were on antipsychotics. I cannot see how they would not be. So there is the very real possibility that it is the antipsychotic causing vitamin D depletion. They don’t seem to consider this possibility, the way I read it they are basically attributing what they’ve found to the condition.

    They say that they have found an association between psychotic symptom severity and vitamin D levels but don’t postulate the mechanism – could it be the antipsychotics?

    Either way, vitamin D supplementation would seem to be no bad thing.

  • It’s a good point, I have wondered about this a lot in relation to my own situation, particularly since extreme independence seems very therapeutic in recovery. I kind of concluded that the problem was not over protection, not directly anyway. It’s a cliche but the social and aesthetic micro inspection that kids suffer from their peers seems to me to be a dominant factor. Bluntly, today’s youth are even more vicious about trivial aspects of the way you look and behave, and there needs to be more emphasis on being decent and supportive (I had to edit my earlier more colourful version).

  • Rasselas, thanks for that account , really, it makes incredibly interesting reading, and I guess you are saying to that the antis here should reflect on what they wish for.

    I would add my admiration for the police, by the way, who react so calmly and non-judgementally, and in doing so gain instant respect which further helps the crisis. If only MH teams had some of that poise and experience.

    Some people here have had good experiences with psychiatry. Others markedly different. We had polar opposites in psychiatrists: one did nothing, the other heavily medicated. I felt deceived, threatened and coerced. I’m not fully anti, but psychiatry is running out of time to discover genuine respect and honesty. I don’t agree with labels because they are permanent and disempowing. I think you should get therapy and DBT if you currently display a need. We were told , sorry, youve not got the right label and it means I can treat your thoughts, mood, anxieties, fears and phobias with chemicals that 100% work. I just cannot do anything but condemn that psychiatric approach .

    I think a big problem is the power the psychiatrist has: both patients and MH workers are scared of what he/she will “do” next that will not be “informed consent”. I think if you simply take away forced medication (except in extreme emergencies) that would change the way the system works. We were never forced, but the threat affects everything.

  • It does seem that Soumerai is simply rehashing an argument made in a 2014 BMJ paper:

    https://www.bmj.com/content/348/bmj.g3596

    The 26 responses to this were pretty critical, focussing on the terribly flawed use of psychotropic poisonings as a proxy for suicide rates, when suicide data is available and of course does not support their claims.

    Also criticised was the presumption that antidepressant prescribing is a good thing.

    So roundly castigated was this study that I for one would welcome any future rehashings by its authors, should they be able to find someone to publish it. It’s desperate really.

  • I agree with you, turtle, that we gloss over the role of diet. If I could maybe offer a reason why we rather stupidly underplay diet, I think it’s mainly because we are thinking of ways to get better, rather than prevention. The other thing is that what you see here is an association that isn’t, for me anyway, proof of cause. Nonetheless, diet should be much more emphasised in MH settings, if for no other reason than to offset for the metabolic effects of the drugs. It’s a no brainer on almost every level.

  • Thanks so much for this Robert.

    It seems that suicide IS well correlated with consistent increases in antidepressant prescription in the US over many years. This is the real alarm bell that should have the FDA sitting up.

    I have been hyper ventilating over this all day, wondering in which parallel universe these academics live. It would be laughable if it wasn’t so dangerous.

    I just cannot believe after all the data and meta-analyses that there is clearly a campaign to increase clinically useless antidepressants in youth.

  • What causes people to stop exercising during and after a mental crisis IMO:
    – isolation and anxiety means you can’t get out and it’s only by yourself anyway.
    – drugs plus condition cause a couldn’t-care-less mindset where the future is irrelevant.
    – drugs slow you down , make you fat, and make exercise much harder.
    – psychiatrist on-the-hoof brainwaves such as “don’t do anything you might fail at” and “don’t mix with other mental health patients”.
    – “mental hospital patients don’t appear to exercise, so it can’t be any good”
    – psychiatrists discourage psychosocial exercise projects – because they work.

  • Beautiful fake science from Stephen Soumerai (Professor of population medicine, Harvard).

    He shows a 40% reduction in youth antidepressants in the 18 months following the first warning, in one US state, Tennessee, in 2003.

    And connects it with an increase in youth suicides in the USA from 2004 to 2016. So, apples and pears, and at different times too. We clearly aren’t supposed to notice that 18 months in one state in 2003/4 is not the same as 12 years for the whole country.

    It gets worse. His graph shows a 25% increase in youth suicides from from 2006 to 2012 in the US. In that period, for the US, antidepressant prescriptions in children and adolescents actually INCREASED by 25% (Christian J. Bachmann, 2016). Professor Soumerai, the increase in youth suicide you cite is correlated with MORE antidepressants, not less.

  • Vanilla, we were not given the patient leaflet for an off-label antidepressant until I kicked up a stink about maximising the dose. Just some pills in a plain white box. Then, 3 months too late, it popped up in a little envelope. This is what is happening.

    The patient leaflet is actually rather vague and evidence-light – it won’t say for example that over 50% get sexual dysfunction. Have a read of one, it doesn’t really put the risks in perspective – and its in tiny print!

  • Vanilla: Sorry this seems like 2 vs 1, but you are making some decent points about the difficulty in bringing psychiatric malpractise to account.

    You are wrong about the UK though.
    http://apopendialogue.org/

    And they are desperately spending to try and stem the mysterious rise in chronic patients.

    On the cost, I have direct experience of that. An hour with the psychiatrist every week to bully you onto medication or voluntary hospitalisation, until you crumble under the combined pressure of the mental issue you are facing and the bewildering claims about your broken brain, not to mention your supposedly broken family. Alot of cost there.

    And the psycho social project? I have to be vague because I genuinely live in fear from psychiatric services. But its 3 or 4 mental health workers to 25-30 participants.

  • The problem with the “anything goes its a market” is that it permits voodoo, homeopathy and….drugs from shonky drug trials that have feeble efficacy.
    Medicines agencies and guideline bodies have allowed commercial interests to influence clinical recommendations. The public needs to know this.
    Your questions:
    1. Direct To Consumer advertising reassures people that the answer is always a pill. You absolutely don’t need it.
    2. The affordable alternatives are psycho social initiatives, community and sports projects, and a psychological approach that starts with “you are not broken”. These exist in parts of the UK, and work by giving people a reason to live and flourish. You have to see it to believe it.
    3. If the psychiatrist makes a strong recommendation to take a drug, and they are quite pushy about it generally, he should provide evidence of efficacy and harms, dosage, duration and prognosis. Evidence, not platitudes or myths or plain falsehoods which should be accountable in law. For example, I do not know where to take my complaint that our psychiatrist was unaware of the license limitations for an antidepressant and failed to get required written consent and failed to mention any potential harms.

    So, if you are looking for what we need to do, it starts with making psychiatrists and institutions accountable for laws that they are probably already breaking.

  • I just want to say that that its good that littleturtle and vanilla express a moderate view, which is essentially that psychiatry and its treatments are the best there is until something else comes along.

    The only thing is, suppose that psychiatric treatments in fact do NOTHING but harm? Is there any merit in this profession then at all? That is where I am starting to find myself.

  • Its an interesting take but I can’t quite buy the argument.

    Psychiatry is not discriminating. It damages everybody with every single medical treatment it prescribes. Its not damaging less able bodied people more is it? A toxic neuroleptic is just that, pure and simple, it has to just damage everyone doesnt it?

    Be careful, psychiatry loves it when it can identify “certain vulnerable individuals”*, who, through no fault of the psychiatrist, have had an adverse reaction/got diabetes/taken their own life. They play the divide and conquer game, saying that they weren’t to know that it was going to be you who would have your health wrecked.

    LittleTurtle, I know where you are coming from. But unfortunately this profession, this industry, these institutions have knowingly misled patients and damaged them in a concerted, funded campaign of deception. Its hard to come back from that. In any event, they only change when they experience the fear of public accountability and outrage.

    * Prof Pariante, to Parliamentary Committee

  • To be honest, he and others on the SMC will be hoisted on their own petards. For example, the statements they made via the SMC in February 2018 to try and mislead the public simply incriminate them in dishonesty.
    “compelling evidence for efficacy” Glyn Lewis
    “confirms that they are safe and effective” Carmine Pariante
    “puts to bed the idea antidepressants don’t work” Prof Anthony Cleare
    “confirms existing evidence that antidepressants do work” Prof Allan Young
    “much more effective than placebo” Prof David Taylor
    Not one of them would attempt to defend these statements and are probably regretting they made them.
    Just a quick reminder, the effect size for Prosac in the meta-analysis to which they are referring was a clinically invisible 0.24, and all the UK’s first choice antidepressants fell below NICE’s minimum threshold of 0.30. I think they have a case to answer.

  • There is a pattern I see where the basic study is honestly reported, and then the conclusion is spun. The data shows ADs to be fairly useless, but the conclusion says they are effective, meaning this only in a technical statistical sense. So the papers conclusion is highly tenous and nearly a flat out lie but not quite. It’s as if you have to conclude ADs work despite your data.

    Then the press release and surrounding statements take that conclusion and amplify it to dishonest levels.

    The profession actively wants dishonest reporting to justify the status quo, they are desperately covering up the increasingly obvious catastrophy. I may be an optimist, but I do think the genie is out of the bottle and the game is up, as carers, journos, insiders and patients are quick to voice their disbelief.

  • Great story, I hope things are working out well. You must know that changing countries, divorce, plus being highly articulate and driven are all indicators that life will not always be plain sailing. Definitely bang in the supplements whether they work, or you think they work its just fine, the way forward doesn’t have to be logical and ways of coping may come from odd places, but I think they come if we are open to them. I speak as someone who was very corporate, spent my twenties thinking about nothing but promotion on the company ladder, only to realise quite late in life that the best bits of me are actually the softer side – and I know why that is too.

    As an aside, I think the drugs are a terrible trap. I’m afraid to say that the line the they “work for some people” has to be claptrap – either there is a mechanism for their efficacy or there isn’t.

  • Prof Pariante is just trying to keep the plates in the air long enough to calm down the current furore and get to his next job.

    The methods he uses could have come from an MBA Marketing course. If the case against you is overwhelming, pick small areas where you can claim a win. (a) So he picks one item out of the depression scale, and although that is riddled with publication bias, claims a win. This one doesn’t seem to fool anyone.
    (b) If the response curve is bell shaped, then at the end of bell must be some people who respond. Apart from the obvious jokes, he ignores the placebo effect. This one has people scratching their heads long enough to move on to the next topic.
    If , on the other hand, as in front of parliament, he is faced with a gullible audience, he goes flat out with “all the studies….working on the core of depression…no doubt about it….”.

  • I think the peers are in on the scam, not to put too fine a point on it. I don’t know who the peers are who review this, but the RCPsych, Kings College and the SMC blatantly authorise false statements (eg the 2 week claim, the “much more effective than placebo” nonsense).

    The 2018 Cipriani meta-analysis is a case study in spin. It span the line that AD’s work when their own data showed an effect size of only 0.3 and for the the 2 most popular AD’s, only 0.24 – totally inadequate to justify the “efficacious” label. Taking refuge in rosy looking “response rates” fooled people only until they read the appendices.

    What these spin-meisters have achieved is to show it’s all nonsense – the whole psychiatric drug shebang. The cover-up is so crude, so blatant, so dumb frankly, you just know where to look for evidence of deception. If you go ferreting around the anti psychotic studies, the same pattern starts to emerge.

    I think psychiatric drug studies have brought medicine into disrepute, aided and abetted by “experts” who are too corrupt and too thick to control it.

  • Fred77’s comment is spot on.

    The Diagnosis–>Disorder–>Treatment model is disastrous, because it “otherises” and makes people thinks their brains are broken, which means they may never really feel fully better because they will always define themselves as having an abnormal brain.

    Thats why “recovery starts with non-compliance” is so true: once you’ve decided (and there’s loads of evidence) that it’s psychiatry, not you, that has lost the plot you can feel the hope that you aren’t broken.

    The problem with “illness” and “disorder” is that, given the treatments have such doubtful efficacy, it sounds permanent and is therefore debilitating, when these problems are very likely episodic relating to circumstances or stage of life.

    I honestly believe that voice-hearers aren’t just normal, they are special. I don’t have evidence for that, just as psychiatry has no evidence that they are disordered. But its a much more helpful belief, and there most certainly is evidence that if you believe something helpful then you will get better faster.

    Most of us can only function because of some of the “disordered” beliefs we have. God? Praying? Heaven? Ritual? Love? Nah, those don’t make sense!

    As an aside, I shudder when I recall the long monologues from the psychiatrist about how the paranoia and anxiety was an abnormal, “serious psychotic” illness that was “psychiatric” not “psychological”. But as time rolls on it just becomes laughable.

    I thought Fred77’s contribution was really well put.

  • The actual way the drugs were developed is really sad. They think they see a drug that makes a difference, then develop variants of that drug, then spin and tweak the required 2 studies to get FDA approval. Then you look closely and see that none of them do anything meaningful. Because at no point did anyone understand any pathology that they were addressing. I think the classic is the rock star clozapine. If it really did work, it would fly in the face of all the dopamine theorists. Well the latest is that, it doesn’t seem to do an awful lot, and the original approval looks fishy. But because of its apparent success, we got an attempt at a me-too, quetiapine, at which point it really looks like you have a drug which is purely side effect. Designed? Discovered? Developed? I think contrived is the best description I can think of.

  • I’m always very wary of such “it’s nuanced and complicated” arguments. There is something at the heart of the system that is dishonest, damaging , over-powerful and corrupt: psychiatry. This much is simple.

    The question of “is a diagnosis a helpful thing” is best answered with honesty. A phoney diagnosis has to be a bad thing.

    I would throw on a cheer for carers who are really important for blindingly obvious reasons. They know the person, often a child, so they are much better placed to put it all in context, and yes they do need help and respect. Our experience was rather Alice on Wonderland with the psychos misunderstanding our fundamentally good family and even trying to suggest that we might be part of the problem, although “you guys are doing so well”. It seemed bunkum to us . They didn’t seem to have a clue, we need help from someone independent of those note taking, meeting going, scared little people who are never there when things go pear shaped. Sorry that’s just my experience.

  • Steve, I wonder what you think about this. I had a very reasoned discussion with my other half who said the diagnoses are helpful because we can define a group of people with a similar problem and provide help. I used to believe that, but have come to the conclusion that you cannot diagnose a biological condition without an identifiable mechanism, I think you call it pathology. Mental problems aren’t disorders because we don’t know if there is anything wrong. I just wonder if we are lacking a word for “we’ve a hunch it’s something we’ve seen in other people and we’ve got a few interventions that seem to help”.

  • I must say I agree . The idea that these drugs were designed is not in any way in accordance with the evidence, read Joanna Moncrieff.

    I’m afraid its all codswallop, or as jock mcclaren would say , bullshit. The drugs don’t make anything better (see the effect sizes, smd, or NNT) and your brain isn’t broken.

    Not sure who said it, but my belief is that “Non compliance is where recovery starts”

    I find it difficult to credit these drugs with anything, I just can’t find it in the studies.

  • Interesting that the adverse effects showed up so early. We all know olanzapine chubs people out but within 12 weeks is going some.

    You have to wonder what on earth psychiatrists think they are doing. Prescribing off label, not just in age but also in application. How can non psychotic youth be given an antipsychotic? And they will max out the dose because of course these drugs are inneffective at making people better.

    And the deceitful codswallop that goes with it:
    “Well I think you could put on a bit of weight”
    “20mg olanzapine is a small dose”
    “You take them for a while , like antibiotics”
    “We can medicate those bad thoughts and emotions”
    “They normalize a chemical imbalance”

    The sedative and weight gain properties are the main mode of action. Any mental improvement is a rather hopeful side effect , and the more studies you look at the suspiciously smaller it becomes.

    Psycho social is what these troubled folk need, from the family , community, hobby groups and psychologists.

  • Thanks for this Sera.

    The thing that chimed with me was in the Mackler film where I think its a therapist who says “first one family member, then another and another, you do the basics, food, exercise and people who like you , and build on that”.

    It’s also very difficult to overcome our natural wish to restrain someone, but actually one of the only things that’s driving them is an unusually intense desire for control and independence. So, rather counter-intuitively, I think it is that feeling that can help them go forward.

  • Its worth savouring the words of Professor Pariante to Parliament in 2016, which are 100% poppycock:

    “all the clear evidence of studies, meta-analyses, and ecological studies confirms that antidepressants decrease the number of suicides…. and a decrease in antidepressants especially in children is mirrored by an increase in suicide rate… there is no doubt about it”

    “it comes about as a result of the anti-depressant effect, which amongst other effects, works on the core of hopelessness and helplessness”

  • I think its fairly easy to argue that physical exercise, in and of itself, has limited impact. The type of exercise really matters: it should be enjoyable, ideally it should have a social element, and should be matched to the abilities of the patient, who will be significantly physically impaired by antipsychotics.

    I have seen a highly professional exercise based project that in my view is very effective indeed and becomes the main route to recovery. And the social element really matters as it helps restore confidence to people who may have been hospitalised or isolated. Its hard to get these people moving again but a joy to behold. It is thought-provoking to see people clearly hampered by the medication working so hard, against the odds, to get back into life.

    I wish psychiatrists would see how their medications stop people moving, but they don’t care. My experience is that they actively want to discourage you from too much activity where you might think you need to work and on occasion fail to meet your target. They would rather shut you up frankly.

  • Thanks! The “high-ranked suicidologists” justification for AD’s preventing suicidality in adults mainly provided by a small 2008 study by Mulder in which patients stated that their ideation had fallen significantly after starting antidepressants – interesting but more of an opinion survey.
    Further support is provided by Cipriani/Geddes (2007) who said “there is evidence that SSRIs may increase suicidal thoughts, but not actual suicide, in early-phase therapy”. The Coupland study disproves this with 200,000 real life patients and real suicides.

    Their evidence for the safety in children came from the TADS study on fluoxetine, CBT and placebo. Robert has written on this in his book “under the influence”: basically, Swedish researchers in 2015 found a a 4 fold increase in suicides and ideation (“events”) that TADS had not reported, and Robert points out that 17 out of the 18 suicide attempts were on fluoxetine, and none on placebo.

    I think the high-ranking suicidologists are good at going through lots of abstracts and press releases, but maybe not so great with data.

  • @pfluft: Interesting. Robert does mention this study, in connection with the 1 month high risk period on commencement and withdrawal which this study underlines. The reduction of risk on after giving up antidepressants at 5 years that you rightly point out will be represented as “look, the tablets worked”. It’s hard to know where to start with that one.

    A couple of other interesting points, although you have to bear in mind the number of suicides was not huge. The risk of completed suicide is actually higher in the month of stopping, particularly for Mirtazipine and Venlafaxine. These deaths must be due to withdrawal and are therefore preventable – the “original condition coming back” argument within a month is really feeble.

    For suicide and self harm together, it is the first 28 days that are really bad – there is no doubt that this treatment will cause alot of people to self harm, many of whom for the first time. Nice.

    To me, psychiatrists prescribing antidepressants, particularly in under 18’s , particularly Mirtazapine, as a suicide prevention measure, is reckless. I don’t see how you could possibly think that AD’s reduce suicide risk, but even if you stuck your head in the sand and said they did, how could you possibly expose your patient to much greater risk for that first month, and the risk upon withdrawal, without at least written consent in full to the dangers of the “treatment”. The “we’ll monitor you” argument is totally bogus, they are not there at that 2am moment.

    Incidentally the BMJ reponses are worthy of a chuckle. One says that AD’s DO reduce suicide risk (unsubstantiated) and Mirtazapine and Venlafaxine are just not so good at it it – extremely scientific. Another one is even better, the problem must be low dosing, so ignore the dose relationship, whack ’em in harder and faster and they won’t feel a thing!

  • I’ve been very intrigued by that cohort study by Carol Coupland in the UK. It was a large population of 200,000 adults with a first episode of depression – what they were prescribed, and how many actually completed suicide. What it doesn’t do is provide a meaningful comparison with no antidepressant – this is real world and there is no placebo. But what I found fascinating is that most antidepressants had similar incidence of suicide, amongst both tricyclic and SSRI’s. Except 2. Mirtazapine had 3.7 times as many completed suicides as the typical SSRI and Venlafaxine had 2.2 times as many. And this was consistent with another study of over 65s. There is something very wrong with these drugs. Venlafaxine has been criticised for bad withdrawal affects amidst arguments that it is an opiod. Mirtazapine would seem on the face of it just to make you fat and sleepy, and its not an SSRI. I was really quite perturbed because I know that in the UK they will prescribe Mirtazapine to suicidal adolescents – almost breathtaking recklessness if you believe the statistics.

  • Am the only one here that honestly doesnt think the ‘Likes’ thing is a big deal?
    Blimey, if it upsets people, then don’t do it. I thought it was a mildly interesting idea, but it really doesn’t matter to me, or I expect, to most other folk.

    My suggestions would be
    (a) Private messaging system, because you do kind of get to know people on here that you might like to contact privately.
    (b) Make the “threads” under each topic a bit easier to control and navigate, mainly visual stuff although it seems a bit hit and miss whether your comment goes on the end of a thread or at the bottom of the comments.
    (c) Someone has made a point about comments that misrepresent a scientific paper, I’m not sure about the context, but accurate evidence should be at the core of what MIA is about. Don’t know what you could do.

  • @Steve: I know, it seems so debilitating because it appears so compassionate – “….you just feel like you’re failing. It’s trying to lift weights without the use of the arm”. So now the “illness” is being equated to amputation. And you know what’s coming next “but the good thing is, the imbalance is treatable…”

    It’s one of the many things I look back at and think – did I really hear that?

    And I think a lot about kids still inside waiting for the use of their “arm” to return.

  • @Steve; The psychiatrist will say , seductively and rather insidiously “it’s frustrating for the patient to be encouraged to build their confidence and self esteem, because they will just feel that they are failing”.

    Instead, the answer is to accept your illness, your faulty brain chemistry, and let me treat it. In other words, it’s not just that you are failing, it’s that you have no hope of success without me. Empowering!

    Quite the contrary. For what it’s worth, I have a feeling that exercising extreme independence and control, “doing really hard things yourself, unaided” is key.

  • @researcher: Some good points on how MH services can increase your suicidality.
    Your point 1 is the killer. You thought they could make you feel better and they don’t . In fact they seem to panic, then they tell you you are distorted and disordered.

    I wonder if I could add a couple of points.

    1. They tell you the meds will fix your thinking and you feel devastated and doubly abnormal when they don’t. If you are untreatable there must be no hope…..
    2. You do what they say and they threaten to imprison you. They even say “taking your life is not a decision we can let you make”. Your ultimate independent decision is about to be taken from you….
    3. They tell you your progress is crap. Your prognosis must be bleak….
    4. They tell you that you cannot fix this yourself, that you need medication. They flip flop and change doses and medication so often that there must be a problem. It’s not working…..
    5. They make no effort to reintegrate you socially, we have to fix your brain first. They are not helping me get back to normal because they know it’s not possible. You sit at home late at night waiting for your brain to fix….
    7. They say it’s an illness, an imbalance , that only the drugs can correct. So either I’m on meds for life to keep me balanced and the ‘illness” at bay, or I can never function again. Or……

    As you say , researcher, how about some hope, belief, reassurance, experience, validation, wisdom, understanding.

    You feel gloomy enough without more doom and gloom from the so called professionals.

    If you go down their route, you will wake up 4 years hence from your zombified state, and feel your life chances have been further hit by being zonked for so long. And you won’t feel very good about that….

    And yet there are psychosocial approaches that work, they are happening and they are real.

  • Fascinating insight. In the spirit of “one step at a time” and “pick your battles that you can win”, how would it be if you just drastically reduced or eliminated forced medication. In other words, you would need special dispensation on grounds of ‘immediate danger to others’ in order to force medication. I know it seems a cop-out and a minor step forward, but doesn’t fake bio-psychiatry start to unravel at this point? Because the threat of hospitalisation has less coercive power, because it loses the bogus presumption that medication is necessarily good, and because for once there would be a population of unmedicated patients, something we haven’t had in decades.

    In the UK they are reviewing mental health law under instruction from the PM, and this small step seems totally reasonable and in line with human rights legislation and WHO.

  • Hi James
    I’m really grateful that MIA exists – it has helped make a positive difference to my situation by educating me. Like real change has occurred.

    For what it’s worth , I think you are on the right lines. “Likes” are helpful because you get feedback on your post. The dissenting voices here seem to come from people who don’t want open minded discussion because they are purely abolitionist, their mind is made up and they don’t want any nuanced debate.

    Good luck, total respect to them, but some of us are on a journey or, like me, in real life situations were I need debate, contra views , and most importantly evidence. I don’t think I care about critical or anti, I want evidence about what works and what’s going to ruin your life, and I want those that stand in the way of honesty exposed and shamed. My mind is pretty much made up, psychiatry in it’s current form IS bullshit, but I still need information and debate.

    I think a private message system would be good too. I realise this is serious work. I even thought of setting up a ‘questioning psychiatry’ forum where everyone can vent off and discuss evidence, but actually we do that here so no need to try and reinvent the wheel!

    Thanks again for your honest efforts and rest assured for folk like me it really makes a difference.

  • We all come at this from slightly different places. I have no doubt that every psychiatric treatment there has ever been is bullshit. My problem, Auntie, is that I can’t help my loved one if I’m anti psychiatry – I’m just ruled offside , not to be involved. If I’m critical (and I am a handful in the psych’s office), I can make a difference here and now.

  • @littleturtle
    There’s an interesting argument developing here about whether you should be tactically anti psychiatry or critical psychiatry.

    I say be guided by the evidence, and if it leads in the direction of psychiatry being unreformable, then your position must be anti.

    I am clinging to the critical wagon, but I do want people taken down, even though I personally liked them. These people lied to patients. So the psychologist that said “20 mg olanzapine is a small dose (it’s the max) – not an innocent mistake, should be called to account. The psychiatrist that didn’t know sertraline wasn’t licensed for depression in children let alone suicidal children – should be called to account. 2 psychiatrists that said it’s a chemical imbalance – stop practising until you learn and speak the truth.

    I think there are decent people who have been simply following orders , but at great cost to patients. In your language , I want them taken down.

  • It’s interesting to see the devices psychiatry uses to defray attention away the lack of efficacy and safety.
    1. The Water Muddying Strategy (also known as the Bundling Strategy). We know the drugs useless but it works in combination with therapy, such a fortuitous combo. So if we provide therapy can we please drug them as well.
    2 and 3. The No Way Out strategy. It seems we can’t find any efficacy over placebo, but for god’s sake don’t stop taking the tablets because bad stuff happens, don’t say I didn’t warn you.

    Prof Pariante and co are endlessly inventive and have further strategies
    4. The “it must work for someone” strategy. If there is a bell curve for response , then surely their is a subgroup who respond well, do let us experiment to see if you are in that group. But don’t mention placebo, which had almost the same response curve…..
    5. The “it must improve something” strategy. Look, item x.x of the blah scale showed an improvement, can we retrospectively look at that instead of the pesky primary outcome which showed no effect.
    6. The Black Is White strategy. Surprisingly effective, most people are too busy gasping for air so it passes unnoticed. Try Pariante’s “all the studies prove antidepressants reduce suicide” or Prof David Taylor’s “much better than placebo”. Important: you do not need any data to back up your claim, it’s just a distraction.
    7. The My Clinical Experience strategy. This again requires no data and the key is to elevate your day to day drug pushing to the the wisdom of Solomon. No-one will challenge you.
    8. The “the products useless but look at the extras” strategy. The drug doesn’t do what it’s supposed to, but has a rather intriguing side effect like “mood lift”, or “helps you sleep (all the time)”. You are looking like you could use a few pounds anyway.

  • @streetphoto: I know it’s all bollocks, as you eruditely put it.

    But I really think the best resistance is to empower the parents, to give them the confidence to ask the hard questions and determine how satisfactory the answers are. They are far too respectful and star struck – the guy in front of them really is not all that sharp or knowledgeable, he’s just trying to keep everyone quiet and doped up and avoid expensive psycho therapy.

    I know official complaints are hopeless, but I detect real fear about kicking up a stink when you threaten to question their competence, particularly if they have been disingenuous, which they always are. And if you do ask incisive questions that imply recklessness, they seem to cave in – they avoid confrontation if at all possible , and prefer the grooming route.

  • @Brett, I admire your courage and objectives. My experience is personal and bitter.

    I think what is needed is an “Informed Consent Card” , accredited by some names or possibly professional body. It comprises questions to ask the psychiatrist and gives internet advice on how to assess the answers given. I was told by my patient not to be a smart-arse, but to ask as many questions as I liked. I admit that this process will surreptitiously trap most psychiatrists who will either fail to provide answers, simply BS or bluster, or point to debunked studies. But such questions are perfectly legitimate. Some questions effective appear twice because the psychiatrist almost certainly will try to evade answering. Perhaps my idea is over ambitious and getting simple answers to straightforward questons would prove impossible – but I think there is something in this approach of asking carefully designed questions. So this is my first draft of an “Informed Consent Card”:

    Parents Informed Consent Card
    ==========================
    Dear Parent,
    Psychiatric drugs are not like other drugs: they do not act on a visible disease process, and they are largely experimental, with correlatory evidence only from quite old clinical trials funded by drug companies.

    Check the answers to the following questions before making a decision to accept medication. Do not accept until all answers are satisfactory for you. Write down the answers carefully.
    1. Is this drug treatment completely in accordance with national clinical guidelines?
    2. Is it licensed for this application, and if not, explain why you are prescribing off label?
    3. Show me published evidence as to the efficacy of this drug?
    4. What is the efficacy either in terms of effect size (Cohen’s d, Hedges g, or Standard Mean Difference) or the Number Needed to Treat? (Refer to internet for interpretation)
    5. How likely do you think it is that the drug will give rise to an improvement?
    6. How much does this increase the risk of suicide or suicidal ideation?
    7. Show me the published evidence regarding suicidality?
    8. What are the common side effects? How temporary are they?
    9. How long will he/she be on this drug?
    10. What is your target dose, and what is the maximum dose you would go to?

    Let me know if I’ve lost the plot!

  • @Brett: Shocking stories of made up diagnoses.

    In each case you allude to something that scares the crap out of me. They believe in the drugs, the psychiatrist has groomed them to believe they have a faulty brain. Thereafter they will take any medication he suggests because that is what they think the problem is.

    And who is most prone to being groomed on this way with subtle references to disorder, imbalance etc? Children, who naturally trust adults and authority figures.

    Psychiatrists are indeed modern day pied pipers.

  • @streetphoto: I like your style!

    But you have to remember the context. You are terrified, you haven’t slept, the doctors notes are even suggesting that you are part of the problem. The psycho thinks you are an obstructive troublemaker meddling with “his” patient, that you just don’t understand the seriousness of the “psychotic illness”. The patient has been groomed to believe this too. Your confidence is shot and you’ve only had a weekend to research a family of drugs. It’s as much as you can do to utter a few trembling words. What I’m saying is that when you are reeling, shocked and shaking, just try and say “sorry, I’m not going to agree to medication until you cite the scientific evidence for efficacy in the long as well as short term, and the
    prevalence and severity of all side effects. I’m sorry, but your ‘clinical opinion’ is not enough for this controversial treatment”.

    Believe me, he will drop his pen and launch into a tirade of BS, but he is compelled to reveal feeble efficacy statistics (ours cited Star-D lol) and he might even just give up rather than be embarrassed and risk a complaint. My experience is that they don’t stand their ground when they encounter knowledge and determination, they know it’s a house of cards. The most powerful weapon they have , however, remains the ability to groom the patient.

  • Thank you for posting Brett, people need to see what child psychiatrists are getting up to!

    The prescription of 2 or 3 “antipsychotics” is truly shocking. I honestly don’t think this guy should be allowed to practise.

    In the UK what I have seen is that they “whack’ in (their word not mine) an antipsychotic and an antidepressant alot of the time. The only warnings you get are about drowsiness (you’ll get over it), weight gain (we’ll monitor it, but actually forget to), and akathisia (we’ll spot it). For the antidepressant, nothing, he didn’t even know it was off label. You get told nothing about metabolic issues, diabetes, sexual dysfunction or suicidal ideation.

    Child psychiatry is the killing fields, you have some of the least qualified people practising unchecked. Their main skill is in manipulating the mindset of the child and the parents, whom they address separately so no-one knows what’s being decided.

    The thing to do as a parent is just say “no thank you, not until you provide the evidence”. I found that they would be very reticent to give you anything (because it’s so weak), and then they would row back and moderate their demands. They will try and make you feel neglectful and delinquent, but if you keep asking for evidence they know you are onto them.

  • Amazing story, do psychiatrists really stoop to such dirty tricks in the US? It has to be a crime. My heart goes out. Aripripazole is a real nasty for akathisia, even our nutty psychiatrist wouldn’t go near it. That kid would have been wrecked, because of course it wouldn’t have worked, they would have maxed the dose, augmented lithium, antidepressant etc

    Speaking to the point about researching the drug, as a parent you just don’t have time. They spring this on you, get the kid on board, and you are given a weekend to figure out what anti psychotics are about. It took me 3 or 4 months to really suss out the crippling damage/benefit ratio of these drugs.

    The bottom line is that, whatever it is, it’s a psychological problem that should never go near psychiatry. I think psycho social, exercise and open air stuff, with some kind of community helps people adjust. Maybe the school environment has gone bad?

    Thanks for posting this, I’m just amazed you aren’t trying to get that doctor struck off, they seem immune to responsibility!

  • @streetphoto: I think we agree. What I’ve seen in the uk is that a private psychologist is great, he works for you and he is the guy you can trust your life with, well hopefully.

    The state NHS “clinical psychologists” work for the psychiatrist, and provide ammunition to drug you or incarcerate you. They are not on your side. That’s why I say , the basic problem is the psychiatrist, who is just a drug pusher but has a whole gang of people working for him. He is the roadblock to enlightenment.

  • I’m from the UK and can only wish you well. I think Steve has it right that you have to hit, concisely and hard, some bullet points that may make the judge stop and think about specific legal issues.

    As an aside, I am aghast that forced treatment exists at all with drugs that indisputably cause damage and very debatably do any good.

    So, are you a danger to others, with evidence. Are you a danger to yourself, with evidence. Is the treatment likely to help (Cochrane doesn’t think asenopine would do much at all). Are you capable of making your own decisions, etc.

    If it was me I’d go through the law in your area and any guidelines you can find, fight them at their own game.

    I hope I haven’t misunderstood the US situation, just wanted to say I feel for you. All the best.

  • @madmom: You make a good point about trusting therapists, social workers and other non psychiatric MH people. In the UK’s NHS they all report to the consultant – the psychiatrist. There is no contract of confidentiality, so you can assume everything you say goes to the psychiatrist , either in writing or team meetings.

    You cannot be open with your therapist because it can lead to involuntary hospitalisation or just very heavy duty persuasion to take ever more drugs.

    I think of psychologists as the listening arm of the psychiatrist.

    As a therapist relationship, that is unethical and there should be a contract of confidentiality or other Chinese wall.

    The upshot is that you don’t open up to the therapist, you play the game, and you will even say thank you the meds are great because you don’t want more shoved at you.

    Reluctantly I think psychology is best paid for privately with someone you can trust and won’t shop you to the psychiatrist.