Monday, September 24, 2018

Comments by ConcernedCarer

Showing 100 of 157 comments. Show all.

  • 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.

    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.

    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.

    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:

    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.

    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.

  • I know, it’s an amazing thing to say, but it’s time Quetiapine was outed!

    If you look at the analysis by Joanna Moncrieff in conjunction with Leucht and Cipriani, the effect size is 0.32, very weak. You hardly need to look further. The most common outcome in a Quetiapine trial is dropout.

    Then consider what Ken Gilman wrote about the proposed mechanism. It does not touch a neurotransmitter that could possibly be implicated in
    psychosis. Shitti Kapur and P Seeman have tried to defend the fact that it doesn’t appear to touch D2 with a “fast off” theory but it’s very tenuous and disproven by Kristoffer Sahlholm. Even the whole D2 psychosis theory is listing dangerously in the water.

    Finally look at what “1BoringOldMan” dug up about the FDA trials. If ever there was a concerted effort to market a drug out of thin air this was it.

    Basically, it’s an antihistamine with some nasty adronergic and muscarinic properties that you really don’t want – and that’s about it!

    I think the games up for Quetiapine. But what of the flagship drug clozapine, with the trial that originally yielded a half decent effect size of 0.88? Leucht recently had this to say “The most surprising finding was that clozapine was not significantly better than most other drugs.” Yes, even the darling of the antipsychotic world is being found out!

  • I do agree with Sylvain. Ramseyer I can see that you are trying to apply a general medical ethics framework, and you come up against the conundrum of whether there was informed consent.

    My own take on this is pretty simple:
    1. You cannot conduct trials on incarcerated patients at all, because by definition, they don’t have a choice. As Sylvain points out, this has grave echos of the past.
    2. You cannot conduct trials on patients as unstable as this. He is already a danger to himself or others, he is already on drugs for sure, he should be excluded from the study on any number of grounds.
    3. It doesn’t feel to me like there was a controlled washout period prior to the study. It rather sounds as if he was suddenly transitioned from something like haloperidol to Quetiapine, which we now know is not, and could never be an “anti psychotic”. That transition should be under the spotlight. You cannot screw with medication like that.
    4. You cannot overrule the carer , in this case the mother, without very good reason. They put the priority of the study above patient welfare.

    The big picture, as Sylvain points out, is that psychiatry hasnt a clue how to treat psychosis because it doesn’t know what it is, and itself suffers from the delusion that sedatives are “antipsychotic”.

  • It’s simply outrageous. Cipriani says they don’t work in under 18s, nice says only prosac (lol) might just do something, and the so called royal college tries to put a gloss that “well at least more people are getting treated”. Mistreated more like. Our camhs psychiatrist didn’t even know sertraline wasn’t licensed for depression in under 18’s, let alone that it’s useless, but still wanted to max the dose. Clueless and callous.

    Stop performing chemical experiments on the developing brain for heaven’s sake.

    It’s all bullshit and camhs psychiatrists have no flipping idea what they are doing.

    Try confronting one with the evidence they capitulate like a soufflé.

  • Fascinating. Where I am, I think I am witnessing a recovery, and it’s because of exposure, community and sport. We’ve had the “the cause is organic , biochemical and medicatable” claptrap and we just laugh, taking bets on how long it will take the next psycho to mention the chemical imbalance.

    It’s clearly not plain sailing and it’s precarious, often gloomy , hard graft. Asserting really firm independence seems to help, as does community. And people who believe .Gaining those morsels of self belief one by one, never going back. What’s starting to come out of the other end is impressive, awakened, loveable, comfortable and reborne.

    The drugs were useless and disabling , the very last thing you need. The psychos studiously attack hope – you’re disordered, broken , imbalanced, and what I find repugnant, “there’s no point in trying to build confidence and self esteem because you will just feel like you’re failing”. They could not be more wrong.

  • Extraordinary story Amy. Our own situation has a similar timeline. This time last year was a nightmare and got worse into the Autumn as each vist to the psychiatrist was a sleepless night of wondering what on earth the guy would do next. Psychiatry made a really difficult situation worse, when you didnt know what was real and what was medication, and they panic and start maxing out doses. But we had nothing like the ludicrous cocktail they put you on. People say its about the money, but I think the reasons lie in Jock McClarens excellent piece. They are a cross between sheep and idiots- I don’t think they have the gumption to be in it for the money. Your treatment has no evidence of efficacy, yet they do it anyway, just to do something, and justify their existence. What they regard as evidence are a few words on a press release, a drug leaflet, a soundbite somewhere. They never dig deeper into the nature of what evidence really is. Like other posters here, I think the way forward lies within is, and it may take time, but letting these twits loose with your brain chemistry is a disaster. So glad you are on the road to recovery and congrats on the degree.

  • Aaah magnificent article , I nearly collapsed over my ice cream when it came to option 1D!

    Just a couple of quotes from 2 different nhs adolescent psychiatrists in the last 6 months:
    “It’s a chemical imbalance that the drugs normalize”
    “The cause is 100% organic I’m afraid , a biochemical imbalance that is treatable (ed: with Quetiapine lol), as uncontroversial as Darwin” (ed: wtf?)

    I think we have to keep alive the notion that they are idiots. Ours didn’t know that sertraline is not licensed for depression in under 18s, but he prescribes it at maximum dose, with no, repeat no, warnings of side effects.

  • Totally with you TRM123.

    Certain biological psychiatrists lie to get you on them, lie about the target dose, what it will do to you, and the intended duration. It’s a con. They ruin lives, ruin families, they are dangerous idiots who bring medicine into disrepute.

    The drug we were prescribed, quetiapine, is a busted flush, a fraud. It doesn’t do anything therapeutic except side effects.

  • Very interesting, good find, and it’s a very large sample.

    It ought to be a heart stopping moment for Psychiatry, which has advanced the theory that medication is required to resist a degenerative process. This was already proved wrong with the macacque monkey study, but, hey, they are just monkeys. So now we find there is a small, barely significant shrinkage due to the condition but that this more than doubles on medication. If you believe cortex volume matters at all (and, actually, does it?), and you believe in “do no harm” you should be thinking, heck, we just made the the thing we are trying to prevent twice as bad. It should be a palpitation moment.

    Instead, as happens so often in papers like this, we get the sycophantic platitudes that this doesn’t mean antipsychotics are bad, because we have lots of (discredited) literature that says they work, without any questioning of that work. Wow, so you think that cortex shrinkage is a price worth paying. If that’s the case, then, FDA and MHRA, that warning should be on the label, now, as follows:

    “studies show that antipsychotics significantly reduce brain cortex volume”

  • I hate to bang on about it, but until the professionals wake up to the fact that the drugs are a fraudulent blind alley, I can’t see anything changing because “treatment” is still defined by medication. And the pros will only change when they see consequences coming at them.

    If that ever were to happen, they might start looking at a new way to characterise mental distress and the psychosocial ways that work.

  • Maybe it’s down to adults, maybe it’s peer group, but there’s no doubt about it, a mental crash is serious and life-threatening. But it frankly incenses me the way the so called professionals label them as disordered, “seriously ill” and suffering from the ludicrous chemical imbalance that only the pros know how to correct. When you hit the skids the last thing you need is BS and undermining. All they ever offered was sedation, false promises of recovery after they’ve mentally crippled you, and the threat of incarceration because you’re still not better. No honesty, no choices, no clue.

    There IS no serious illness, no imbalance, no therapeutic medication, no wisdom, no experience of getting people better. Exercise? Sport? Oooh no, it just makes people think like they are failing apparently. The BS only stops when you manage to push them away.

    Then how about “we believe in you”, “you’re not broken”, “it’s ok to be crashed out”, “we think you are special”, “take your time”, “let’s try and do a few little things”…etc

    …sorry, it’s been a slight rant…

  • Are we surprised that none of this worked? I’m not. The issues these kids have are far deeper than a bit of psychotherapy and an ssri. And you can bet they will have maxed out the dose.

    I think it starts going south when you label them as disordered and needing “treatment”. These youngsters have a problem but of course it’s not a brain disease.

    You have to help get these kids on their feet by having them do things, little by little. The drugs will just numb them up , or possibly worse. Much as I love psychology, I’m not sure kids are amenable to it.

    This study says that current “treatment” is failing kids – the profession simply fails to understand human behaviour. I personally feel it’s the interventions that we call psychosocial that make a difference, just helping them stay plugged into other people and family.

  • There’s no doubt that drug companies do try to invent psychiatric diseases, I think the most insidious is the “treatment resistant” modifier which allows your drug to have zero efficacy in the basic condition and unlimited side effect damage.

    But I think they are aided and abetted by doctors who try and invent more patients with more serious “illnesses” to keep themselves busy and justify their existence – I don’t think it’s just about money. One of the consequences of Psychiatry being found out is that its practitioners seek ever more desperate and bizarre ways to shore up its position, even beyond the DSM.

    But we all have this dangerous habit of sticking labels on patterns of behaviour that become targets for the snake oil guys, so much stuff that gets the shrinks alarmed is just temporary variation, perhaps severe, but within ‘normal’.

  • Duncan, I have enormous respect from the critical stance you have taken. What you are hearing here is rage from embittered “users” who have been lied to and abused. Power appears to have been wielded cynically by a cult of evidence-denying medics, the ultimate power to lock up and effectively lobotomise. The tyranny scales are completely with the medics – how can someone with no choice be a tyrant?
    Please undermine my argument because I can’t believe its not a bad dream!
    Coming back to this article, it doesn’t matter about the patronising skilful speech, full of validation and compliments, that the doctor gives you if it’s simply the prologue to a bunch of psuedo-scientific hogwash and a prescription that will knacker the next 5 years of your life if you are lucky. The keyword for me is understanding. First the doctors need to understand mental issues – I’m afraid they don’t, they are going down a terrible blind alley, and they need to get a grip on the evidence and listen. Then they need to translate that understanding into collaboratively and honestly helping the user.

  • Here in the UK, I think you don’t get psychology without getting psychiatry, and since the lead consultant is the psychiatrist, it seems to me that the psychologist works for the psychiatrist. In practise, the psychologist is the eyes and ears for the psychiatrist, and what you might think was confidential with your psychologist goes straight into the records. I found the psychiatrist then uses this as evidence of “disordered thinking”, that he somehow believes can be medicated until its straight. So basically, as much as I believe in psychology, you cannot give your trust to them whilst they are under the psychiatrists influence. It won’t change until they are separated, I would say that for now it’s better to pay for private psychology.

  • This reminds me of the psychiatrist looking at me saying “wow, I’m feeling a lot of anger”. Too right mate, you lied. Lied about what you could achieve, how you were going to achieve it, how effective your interventions were, what the side effects would be, what were the possible causes. You could have told the truth about your view of the prognosis, what treatments and doses you would be considering, how effective they are, what they do to your body, what is understood about causation, but you didn’t. The only remedy is for this fake doctor to get the hell out of the way, frankly, whilst the rest of us try and help the sufferer chart his/her course to recovery.

    I agree this is an important topic, but for some of us it’s gone too far. Once the Doctor is found out not being fully open and truthful, there is no conversation to have.

  • Rhino: you already know the answer , it’s BS and it is the psychiatrists foremost speciality – they really aren’t very good at science, and are clueless on things like statistics.

    Our NHS psychiatrist was very keen on the mind being purely biological “it’s not controversial at all that I can medicate away your disordered thoughts”, “it’s most important that you hang on to the idea that this is 100% biological, not a psychological problem but a serious psychiatric illness”. I thought he was trying to make people better not preach codswallop , but oh well. Can’t believe we pay taxpayer money to idiots like this.

  • I think the idea of a drug centred model has won “I agree with Joanna”.
    Its extraordinary to think that there was any other model.
    That message has not got through on the ground, however.

    But to me the problem is far worse.
    Leading Doctors are lying to us, that’s one thing, evidenced by that SMC page and also the persisting myth in the clinics of rectifying an imbalance.
    The drugs are either useless and damaging, or have short term benefit and highly damaging, as you and others have demonstrated.
    So, the rules of informed consent, “do no harm” and honesty are violated every day, and this is what people are up in arms about.

  • Steve: Apart from the fact that Psychiatrists themselves are brainwashed that drugs work, the system does have an inherent disconnect. The way they assess how you are doing is a short interview every so often. If you are having a good day, then “the meds are working”. That periodic interview is not enough to assess mental state. You need a round the clock idea of what’s going on, and that’s where family and carers could help but it does need to be a true open dialogue to preserve trust. The information from the patient themselves is paramount of course, but the doctors tend to put words in their mouthes in one to one chats. Family and carers are regarded as offside potential trouble makers, part of the cause. And this starts to become true once you research and quite objectively conclude the doctor is not telling the truth and is trying to manipulate everyone to create a narrative that the drugs are working. The threats of hospitalization then demonstrate that this is not a team where we are all on the same side, and then you realise that everything you say gets twisted to assist their narrative. The trust in the psychiatrist goes whilst the psychiatrist tries to drive a wedge in the family “why don’t you just trust in me”.

    At that point, the problem is actually the psychiatrist, because he is clearly revealed as dishonest and manipulative, and his obsession with the drugs means that, outside of medication, he’s actually a useless busybody, a dangerous snake oil salesman who has no idea how to make people better.

    The psychiatrist has too much power, and the psychologist, who works for the psychiatrist, just provides more material to be twisted. The system is unfixable until the Psychiatry either embraces psychosocial approaches or psychiatrists are are relegated to the role of pharmacist, or someone assumes responsibility for care who is educated and honest.

    As regards sexual side effects, they say nothing, the patient says nothing, and when you raise the possibility the doctors will then say, “look, it’s obviously all a myth”. The patient will never say anything, and is going through hell on earth anyway so won’t talk about it. The doctors find it very easy to brush this scandal under the carpet.

  • I’m not a book reader but I got Lauren’s history of psychiatry on 10 treatments after reading that daily mail article. There is something fascinating about her recognition of the damage, with the unblinking acceptance that it’s necessary. I gave up about 2 thirds through when there were too many “transformation” stories and ‘scientists believe’. Like someone has said, it feels like this gifted writer has been brainwashed and she needs the mythology kept alive to justify where she has come to. To arrive at the conclusion that your health has been irreparably damaged for nothing may be too hard for any of us to accept. Finally I think I was seeing a story about hope for the future though new drugs and decided that what was about to follow was cobblers.

  • The sun is shining, and I think we’re gonna win Auntie 😉
    (1) They will have a hard job BS-ing increasingly educated service-users. I’m just an average punter, and for me the game is up. We know the evidence, we know their BS tactics, the imbalance/broken brain/chemical experimentation shenanigans, we know that they are out to suppress not recover.
    (2) The much derided NICE guidelines will increasingly have to point out the lack of efficacy and dangerous side effects. Have a read, for adolescents they already present restrictive criteria – capable of blanching a psychiatrist when he realises he has even failed in terms of the orthodoxy. And when they next review the Maudsley guidelines, Prof David Taylor will be forced to thumb through to page 150 of the Cipriani appendix – thats where his Final Answer really lies. See if he has the lunatic courage to recommend Cipriani’s lethal table topper – he won’t of course, but he may well try and promote the other gruesome top 3, which would demonstrate culpable irresponsibilty.
    (3) Once the drugs are discredited, the psychiatrist is sadly redundant – I’ve seen it – they just don’t know what to say. I say sadly because we need properly trained medics in mental health, and at present these doctors are a waste. Then maybe you get your collapse, if that’s what you want, but I’m not so sure.

  • Yes, behind Prof Pariante’s “bell curve” and “small but consistent response” nonsense lies a pseudo-belief that they give rise to neurogenesis, and increasing the churn of brain cell regrowth means less depression. I think a baseball bat to the head is similarly therapeutic! (oh wait, isn’t that ECT?)

    I say pseudo-belief because he’s floundering about trying to convince himself, and next year it will be something else (anti-inflammation? body temperature?).

    Above and beyond trying to inform myself and to resist the recklessness of uninformed quacks, what gets my goat is that they show such ignorance and disrespect for science, distorting and contorting arguments in spite of the lack of evidence, or evidence to the contrary.

  • I know what you are saying StreetPhoto, but I hope you forgive my naivety in my support for the Critical Psychiatrists. Looking at that debate with Pariante, he basically gave in on most issues and where he wanted to hold his ground he offered up such a feeble case that it fools nobody. He even thought that a bell shaped response curve means that there is a cure in their somewhere – thats a primary school error. I am new to all this, and believe me I wish I had never heard of psychiatry, but I see a shift in the face of a barrage of evidence that has already severely damaged the reputations of Pariante & Co. And it won’t stop until key people step aside.

    What Dr M was saying is that in the overall suicide figures she does not think there is a significant component that is down to AD’s – OK, controversial, but honest. Its not quite the same as saying that AD’s don’t cause suicide, just that the numbers of AD suicides don’t in her view affect the overall rate, which has not been skyrocketing like AD prescriptions have. I think thats debateable, I actually do think AD’s are significantly increasing the rate, but I can’t yet find solid proof of that. I can find proof that they cause many suicides, so I would hope she would modify her position given the chance to explain it further.

    There is good analysis from medical statisticians like Carol Coupland who have analysed the increased level of suicides, and provide help to those of us who are having the most risky drugs pushed in our direction on an ongoing basis.

    So for me, to arm service users against the dangerous BS of the bio-psychos, we need hard data from the medical profession to stop their nonsense, so I wouldn’t want that analysis to stop.

    Before you blast me, think about how, in the real world, service users stand their ground against reckless prescribing.

  • Some of the straw clutching from Pariante was delightful , Joanna struggling to keep a straight face, at one point did she seem to fall off her chair?

    Pariante’s main point seemed to be that there must be some people who get significant benefit from the drug in order for the distribution to be bell-shaped, and we just need to find out why, because then we can target the drugs better. Really? Sure about that? What about placebos that have an almost identical bell curve, are we going to target placebo therapy too?

    Then we have that the effect is small but beautifully consistent. What we have, is that the two most prescribed antidepressants in the UK have an effect size of 0.23 and 0.24, when it’s already been agreed that Kirsch’s 0.3 amounts to negligible. So we have been something that does practically nothing, and at what harm?

    Then we had “but just take the mood item”. Slap. Publication bias, only reported if convenient.

    Then we had neurogenesis again. But who on earth said depression was about a shortage of brain cells anyway?

    At the end of the day, flooding your brain with seratonin was a bold 1980s experiment that failed, that’s it, let the hypothesis and the drugs go, it’s over. Put more energy and money behind psychosocial initiatives.

  • There is no doubt that there was an orchestrated misinformation campaign when the paper was “launched”. The journalists understandably trusted the words from authors and the experts. The paper itself started the myth with “more efficacious than placebo” because it sought to portray a small statistical difference as clinically significant. Furthermore, although the evidence for this was the largely unreported measure of the small effect size, the data they used to support this was their primary outcome of relative response ratios in a small subset of improved patients. But ask most people what the study actually measured, and they wouldn’t really know, they just trust the words in the conclusion.

    The SMC systematically ramped up the exaggeration with carefully crafted soundbites – but virtually none of SMC press release statements are valid, each one has a calculated and systematic failure of truth. For example, look for the words “most people”, “much more effective”, “compelling”, “work” and then consider that the UKs 2 most prescribed antidepressants, citalopram and fluoxetine had effect sizes of 0.24 and 0.23, way less than NICE consider clinically significant. And not one of those experts has sought to defend, elaborate or justify what is still published on the SMC website.

    I’m afraid what’s happening now is an orchestrated defence of the indefensible. Cipriani thinks people focus too much on clinical efficacy as if bemused as to the purpose of all the research money that goes into these things. Pariante is back pedalling and is so confused he thinks he said “final answer” when it was Cipriani, so clearly in the bunker the scripts are getting muddled up. And the BMJ is blaming the press for not being nuanced, when the airwaves were thick with over-emphatic BS from those who are paid to be honest.

  • Just thinking about that fateful Cipriani antidepressant study, an NNT was never reported, but I think it might be in plain sight. Sorry this is a long post, but people here are pretty tolerant. Anyway, amongst both placebos and drug takers, 17% were responders. How you can call a placebo a responder beats me, but it’s there in the figures, the 17% who improved more than 50% are 20k cases out of 116k patients. Then, within that 17% the odds ratios varied, but most mainstream antidepressants had, by any favourable view, 1.7 times more drugs than placebos (eg Sertraline 1.67) . In other words, you were 1.7 times more likely to get better with the drug. Sounds great. But hang on, let’s try to get NNT, and I thank Robert for showing how this works. That 17% must be roundabout 6.3% placebo and 10.7% drug to arrive at a ratio of 1.7. Hmm, so a lot of placebos did get better, but if I really want to get better I should be with the 10.7% drug takers. But 6.3% of that 10.7% would have got better anyway! So actually, only 4.4% got better because of the drug, or an NNT of 1 in 23. That’s double what I had in my mind and it’s really poor. And yet this is the primary reason for recommending antidepressants, that they really help a number of patients – a very, very small number!

  • Best regards for your continued recovery Monique. I find it useful to check out the science, and Robert has pretty much taught us how to go about that. I’ve yet to find a pro-drug psychiatrist who will stand their ground in the face of the evidence, so if there is one here who disagrees, I hope they put forward their alternative view backed by evidence, because the orthodox case is somewhat listing in the water right now.

  • Yeah thats a good question, I have heard the “mood lift” property of Quetiapine, for example, mentioned many times. Although I cannot actually see why a drug that sends you sleep, makes you fat and gives you diabetes and metabolic issues would perk you up, but oh well, psychiatrists will believe anything.

    Just googling around, I found an Australian Meta-Analysis by Spielmans from 2013 which mentioned NNT’s of the adjunctive AP to be 7-10 with an effect size of 0.34. Not very good! And the Olanzapine/Fluoxetine combo had an NNT of 19. Oh dear.

    They said:
    “All of the studied drugs except risperidone demonstrated substantial risk of several adverse events”
    “We interpret the effect of adjunctive antipsychotic treatment on depression measures as of questionable clinical relevance.”
    They concluded with:
    “Taken together, our meta-analysis found evidence of (1) some improvement in clinician-assessed depressive symptoms, (2) little evidence of substantial benefit in overall well-being, and (3) abundant evidence of potential treatment-related harm.”

    To me, that’s a pretty rosy assessment of adjunctive AP . Once you get into effect sizes of 0.3 and NNT of 8+ and you know there is publication bias and the depression scale favours sleepy drugs – well you have to entertain the likelihood that there is actually nothing there. The damage done, however, is pretty certain, because thats what these drugs do – primarily they disable neurotransmitters that you actually need working to stay healthy.

  • Agreed Steve. In the real world psychiatrists multiply risks upon risks.

    Where they end up is trying to prescribe, off-label, the drugs most associated with suicides to at-risk under 18’s. At that point they are off-scale and off-data, its blue sky country and the risk is unquantifiable. And I’m trying to work out where “but I have to do something” fits into medical protocols.