Saturday, November 17, 2018

Comments by researcher

Showing 59 of 59 comments.

  • Depression is about the easiest thing to “fix”. Just 20 minutes exercise 3 times pr week gives better results than Zoloft. Add a little bit of hope, better diet, some mindfulness, positive focus and research shows you have a good chance of getting better within s few months.
    Those who laugh at these simple suggestions are usually talking about the artificial depression induced by antidepressants.

  • SSRI, acne and hair loss treatment can also give Persistent Genital Arousal Disorder, which sounds nice but which us described as hell on earth by those afflicted. And the arousal can be permanent even after treatment is stopped.

  • Dr.David Healy has a very good website rxisk.org discussing side effects to drugs. One very serious side effect of antidepressants is permanent sexual numbing, that doesn’t go away even if you stop the drug. Many other horrible side effects may also never go away. And young people are exposed to this by taking a drug that scientifically has been proven to not have an effect!!
    This is also a side effect of acne and hair loss drugs.

  • As usual, very clear and well researched article from you, Bob.
    There are so many ways that the medical model can make people suicidal.
    1. You feel horrible and you are told this is because there is something wrong with your brain. You check with google about the chances of getting better, and you find the words “Chronic”, “recurrent” and “lifetime” associated with your diagnosis. You may then very easily conclude that you cannot live like this.
    2. You get drugs that make you feel horrible, including losing sex drive, having numb genitals, strange aggressive thoughts, nausea, fatigue, sleeplessness, and inner torture (akathesia). You may think this means you are getting worse, and combined with point 1 above may decide that a life like this is not worth living.
    3. If you correctly attribute the above to drug effects, you may think that you cannot live if you have to take drugs that make you so sick.

    4. You may have thought of suicide already but care so much for those who love you, that you have decided to not go through with it. Then the drugs suddenly take away your feelings, and you are able to go through with your plans.
    5. You feel that you are a burden to your loved ones when you are depressed, and then the diagnosis and googling makes you believe that you will be a permanent burden for them. The logical conclusion will then be to kill yourself to relieve them from this permanent burden.

    Instead a good doctor or therapist should inform you that depression is not a disease, that it is in no way permanent, that it will most likely pass by itself, but that with therapy an paying attention to what made you sad ( e.g a n unhealty relationship) you can get rid of it faster, become less suicidal and be better protected against relapse, even though the risk of relapse unless you are treated with drugs is only 15%.

  • It is very interesting that the drug industry and psychiatry now feel that they have to defend their drugs. That means that the wind is changing. They are not going forward with optimism, but they have to defend themselves.
    Those of us who feel that the science behind this should be known by everybody, should use all the tools we have available for letting people now know the facts. Please spread the word about Robert’s excellent article everywhere, and you can freely copy and paste my arguments to any post you would like on social media. If anybody cares to edit Wikipedia articles, they will usually let you make a statement there if you referred to a meta-analysis or literature review. If anybody cares to make YouTube videos, this is also very effective for the younger generation. Making comments to youtubers with millions of subscribers could also be very effective. Maybe they will make a video about Depression drugs.

  • It is quite amazing that the drug that increases the death rate with 66% in older patients can be used at all, however good it is. When we know that these drugs also make people unable to go back to work according to the research above, it is beyond comprehension that these drugs would be used at all. If people knew that Depression drugs increase the death rate of 66%, meaning that people die 11 years early on average when they take antidepressants, nobody would take them. When we also see that the drugs at least double the rate of dementia, the situation becomes even worse.

  • There is probably a very simple reason why depression drugs don’t work for children and adolescents, and why they seem to be better for the severely depressed.

    Children and adolescents are less likely to be on a previous antidepressant when they take part in drug trails. Therefore we are probably testing the true effect of depression drugs in this group. And the drugs increase suicidality and have no effect.

    The severely depressed they are more likely to have been on depression drugs for a long time, and often in high doses, so when these people are put in the placebo group, they have a worse withdrawal response than other patients. This is exactly what the results show: The depression drugs don’t work better in this group, but the placebo group is doing worse, so it seems like the drug it’s more effective. It is quite obvious that the person who has been on depression drugs for years and then goes cold turkey, will be doing quite badly for the whole eight weeks.

  • The drugs are not tested on the people who will actually use them. This is like testing drugs against pneumonia and patients who have stomach problems. 90% of the patients will take depression drugs, or not the patients that the drugs have been tested on. This means that we have no evidence base for using these drugs for 90% of the patients who are taking them.

  • Depression drugs are tested by the companies that make them. This is like Pepsi testing if Pepsi is better than Coca Cola or a mobster being judged with only family members in the jury or a judge asking the accused to provide condemning evidence in his own trial. In all other areas of life we disregard the results that come from these kind of testifying on your own behalf.

  • Depression drugs are compared to cold turkey withdrawal in the placebo group. Even if people in the placebo group are in total abstinence from their previous drug, they do so well without their drug that neither patients nor doctors would be able to know the difference. The placebo group gets as good results as the drug group one week later.

  • Selection criteria are extremely important in any meta-analysis. You can get almost any results you want if you choose the studies you want to include. Here the researchers asked the pharmaceutical companies to provide unpublished trails to their liking. It is quite obvious that the companies would then be able to supply information that was to their advantage, that didn’t have to go through the rigorous process of peer review to be published. So including whatever the pharmaceutical companies wanted to provide, even if it sounds like this is being very thorough and searching for unpublished data, this is not science.

  • This article could be an example of how to manipulate study so that it seems to produce very positive results. If you have enough patients in the study, you can find so-called significant results of almost any difference. The difference can be totally insignificant, but it will show up as statistically significant, and be called significant in the text. Most people don’t realize that we are talking about statistical significance, and not clinical significance. In the appendix of the study they published a standard mean difference between placebo and the drug And this result was in the very weak range, actually weaker than the Kirsch et al study, that claimed that the antidepressants don’t work. The so-called significant difference between drug and placebo is approximately two points on the Hamilton depression scale. The difference has to be at least three for either patient or therapist to notice a difference. So what this study has confirmed, is that antidepressants can create a totally insignificant difference compared to a placebo pill.

    The placebo pill is often combined with attention and close follow up with a professional, and this has a very positive effect. So actually what we should do is give a lot of professional attention, testing and preferably some kind of therapy. Antidepressants don’t add anything, and many people say that it’s hell on earth to discontinue them. And 70% lose their sex life with these pills, for nothing.

  • A problem with this study, and most of the individual studies it is based on, is that patients who take part in these drug trials have been on an antidepressant before the trial . They are then put on placebo for 10 days , a so-called washout. Then half the group, now in cold turkey witdrawal , is now put back on a similar drug to what they had 10 days earlier, and the other group gets to continue their Cold turkey withdrawal.

    That means that all these studies are testing how good it is for patients to go back on a similar drug compared to being in withdrawal with a lot of abstinence symptoms. It is then actually quite surprising that the placebo patients are doing so well. The studies actually show most patients can stop their antidepressants and do quite well.

    The fact that these studies are just testing relief from abstinence symptoms by taking a similar drug, could explain why there is no effect in children and young adults. Many of them may not have taken any drug before they try the antidepressant.

    This testing of relief from abstinence, may also be the reason why the results are better with very serious depression. People who have very serious depression will most probably be more addicted to higher doses of antidepressants already, and have quite bad abstinence symptoms when they are put in cold turkey withdrawal.

    What is actually quite amazing is that the placebo groups reach the same level of reduction of depression as the drug group, only one week later. Why not wait?

  • The whole article is here.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

    It is so short I thought it was the abstract. The whole article is quite strange.
    Here is a quote: “We contacted all the pharmaceutical companies marketing antidepressants and asked for supplemental unpublished information about both premarketing and post-marketing studies, with a specific focus on second-generation antidepressants. We also contacted study authors and drug manufacturers to supplement incomplete reports of the original papers or provide data for unpublished studies.”
    That means the drug companies could provide any data they wanted and exclude whatever was not in their favor.
    Another problem is that all these studies rely on patients who are taking antidepressants before the study and stop taking the drug cold turkey. Then, after 10 days half of them get back a drug very similar to what they were taking. The placebo group continues their cold turkey withdrawal. It is quite obvious that people feel a lot better when they get back a similar drug compared to being in withdrawal.
    So all of these studies are not testing if antidepressants work, they are just showing the obvious: that getting back a drug is more pleasant than abrupt cold turkey withdrawal.
    In addition, the placebo group reaches the same level as the drug group one week later. Why not wait?

    What is Really strange with this Research is the standard mesn difference which is a messure of how much higher the response to the antidepressants is. The authors admit it is modest: 0.31. 0.2 is considered low. 0.5 modest. This is actually LOWER than what Kirsh et al got when they determined that antidepressants don’t have any clinically significant effect.
    It doesn’t matter that the antidepressants all beat placebo when the difference is so small that neither the patient nor the doctors can notice it. It is only when you test thousands of patients lie this study does that the very small difference will show up.

    And almost all the studies were done by the manufacturers.

    Another strange effect is that when a company tests their antidepressant against another, their drug always becomes the winner. Here the authors call this «the novelty effect”
    It is just like Pepsi and Coca Cola are running their own trials to find which is more tasty.

  • The whole article is here.
    http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)32802-7/fulltext

    It is so short I thought it was the abstract. The whole article is quite strange.
    Here is a quote: “We contacted all the pharmaceutical companies marketing antidepressants and asked for supplemental unpublished information about both premarketing and post-marketing studies, with a specific focus on second-generation antidepressants. We also contacted study authors and drug manufacturers to supplement incomplete reports of the original papers or provide data for unpublished studies.”
    That means the drug companies could provide any data they wanted and exclude whatever was not in their favor.
    Another problem is that all these studies rely on patients who are taking antidepressants before the study and stop taking the drug cold turkey. Then, after 10 days half of them get back a drug very similar to what they were taking. The placebo group continues their cold turkey withdrawal. It is quite obvious that people feel a lot better when they get back a similar drug compared to being in withdrawal.
    So all of these studies are not testing if antidepressants work, they are just showing the obvious: that getting back a drug is more pleasant than abrupt cold turkey withdrawal.
    In addition, the placebo group reaches the same level as the drug group one week later. Why not wait?

  • All of the errors an weaknesses of antidepressants RCTS pale in comparison to this: almost all participants are on an SSRIs before the study. They are all stopped abruptly and given a placebo for approximately 10 days. By this time most have heavy withdrawal symptoms which will give a high depression score. Then half the group is given the SSRI being studied and the rest get to continue in cold turkey withdrawal. Anybody who gets back a drug they are in abstinence from will feel a lot better. This is the standard thing people do when they are hung over. They take another drink.
    So we are no at all measuring the drug’s antidepressant effect, but just how much it decreases abstinence.
    What is strange and encouraging is how well the placebo (cold turkey withdrawal) group is doing. They are hardly worse off than the drug group, and many placebo responders (those who get so much better from cold turkey withdrawal that they cannot participate in the study because they are not depressed, typically 30 %) are already removed from the study. So actually the only thing these studies show, is that a lot of people get much better from STOPPING their antidepressant, even if they do this abruptly.

  • If you define death as something you don’t come back from, then of course nobody can ever come back. This is s bit like the circular diagnosing in DSM. The definition serves no purpose. What about people who get information from those on the other side? There are over 20 research fields pointing to the reality of life after death. Those who argue against usually have not read this research.

  • I just tried to donate. I discovered that I have to put my visa number on a page that appears to be not secure/encrypted and it would not accept the donation because the site already had my email registered. So I was not able to donate…
    Could you please make the page secure so that we don’t risk anything by putting up our visa numbers and don’t have to get a new email to do it?

  • The only reliable difference between the so-called ADHD group and the so-called normals is the drugging. There are over 700 varieties of so-called ADHD, and the field tests for DSM 5 showed that diagnosis is a very unreliable process. A child diagnosed as ADHD by one doctor may not be so diagnosed by another. But we can be fairly sure that if the child or youth has got the label, drugging will follow. Actually what this study shows very strongly is that ADHD medication can more than double the accident death rate for young people. Death from suicide and medical problems such as sudden cardiac death from Ritalin have already been demonstrated. So now we can add a doubling of accident deaths to the list.

  • This TMS study suffers from so many methodological problems that it cannot be used for anything.
    The most blatant error is that there is no control group and no placebo. TMS is a new fancy looking treatment with high tech equipment, the perfect treatment to elicit a good placebo response. And the results here, approximately 1/3 got remission, is a typical placebo effect of almost any kind of intervention.

    The problem with almost all ECT research is the lack of a control group getting a placebo/sham treatment and being exposed to the equivalent medical attention and optimism. now TMS research is repeating the same mistake.
    Without a control group we cannot say anything about neither effectiveness nor safety.
    When the researchers use the extremely subjective CGI as their primary measure and two of the researchers are employees of the device maker (and the others have serious conflicts of interest receiving money and grants from Neouronetics), this is close to a farce. That such research is taken seriously at all tells a lot about the field of psychiatry.

  • Let us take a more down to earth example that many can testify to: alcohol intoxication. Can alcohol change the complex behavior of talking to persons of the opposite sex? Can it make a shy person suddenly talk easily with others? Can alcohol make a person suicidal just like SSRIs. Of course!
    Here is a typical quote
    “Dr. Philip A. May, professor of sociology at the University of New Mexico in Albuquerque, said alcohol plays a role in about 40 percent of suicides in New Mexico. “The younger the individual, no matter what ethnic group, the more impulsive the suicide is, and the more impulsive the suicide is, the more likely alcohol is a major factor or trigger,” Dr. May said.
    http://www.nytimes.com/2009/06/19/health/19suicide.html?_r=0
    How can a drug influence a complex behavior. Probably not by starting up a complex chain of thoughts, but by lowering inhibitions to already occurring thought patterns. Almost all depressed persons have thought about suicide as a remote possibility at some time. Most have decided against it e.g. because of concern for the family. Many of my patients say” If it wasn’t for my children, I would have killed myself”. I believe them and feel safe that they will not do it unless they start with SSRI or drastically alter their dosage.
    If SSRI is started or abruptly changed, many patients report an emotional blunting, including caring much less about other’s feelings. This may be the most important factor in causing suicide or violence: not caring how it affects others. The mother above would no longer have the brake on her already existing urges to end her life, she would care less for the children’s feelings and be able to take action.
    Would we be able to measure this in the woman’s brain? Probably not, but she has ingested a chemical just like alcohol, and we could measure the blood concentration. we have a biomarker for suicidal risk: alcohol or SSRI in the bloodstream. Combinations of several SSRIs and alcohol is probably worse.

  • Can medication be responsible for complex behavior? It seems like _anonymous is against the thought that medication can be responsible for any kind of complex behavior including suicide and violence.

    Maybe we should let the scientific method help us. If a double blind placebo controlled study shows that patients who don’t know if they are taking placebo or not suddenly report suicidal thoughts and actions, we could use this as an indication that the drug induces the thoughts and behaviors if the medicated group reports 6 times as many incidents as the placebo group.

    What else could be causing the thoughts or behaviors if the research is done according to protocol? The pharmaceutical companies would like to see the opposite effect and they are running the study.

    I have had patiennts who have acted completely out of character the moment the medication has been changed. Some have told about aggressive impulses they never have had before. Should we disregard their experiences? Sholuld we disregard the scientific method?

  • I would like to excuse myself for having made so many posts instead of just one long. However, we might discuss how difficult it is to scroll to the next post vs the effort required to press Read more. The read more may seem offensive to the author, signaling, “now you have become too expansive” when the author just wants to make a thorough argument.

    Personally I just copy the whole thread and have a text to speech program read it to me e.g. while I drive or do chores, and now I manually have to expand all posts to get the full discussion. Would it be possible to have one button at the top choosing expanded or reduced view for the whole thread?

    There is a justification for splitting up posts if there are many themes: The splitting allows for direct relies on topic, instead of people replying to 4 or 5 different topics with the same reply button. So if I have diverse themes in the future, I hope you will not be irritated with multiple posts.

    Another advantage with split posts is that some of the content may be moderated while 90% is ok. Then we would miss the 90% because of maybe one offensive sentence.

  • Shipko has no research to back his claims. He is probably seeing the 1 in 10 000 who seeks him out because he specializes in these problems. (see my analysis at the bottom of this post)

    He is also probably writing this to market his 28 page “book” for $ 4.75. Those who really want to help, like Monica, give away the information on their website. It is not difficult to put 28 pages on a website.

    Shipko also serves the pharma industry well by scaring people away from stopping SSRI. He is probably worth millions to the industry!

  • One could suspect Shipko for being funded by the pharma industry, and actually be more useful for them than many others. He can scare people from stopping SSRIs and this will benefit the drug industry enormously, especially now that people may think twice about starting SSRIs. After all there are millions that may continue indefinitely with their SSRI because Shipko has scared them so thoroughly with an article based only on his opinions and very selective observation.

    If you know of someone who is thinking about starting or stopping a SSRI, please consider sending them a copy of ‘Informed Consent.’

    Free advertising for his overpriced “book” that was published 16 July 2013 and is already ranked as nr 19 in psychopharmacology, higher than “The Emperor’s new drugs” by Kirsch.

    And again: Not a single reference!!!!!

  • Analysis part 11
    For this reason, I recently published an eBook, “Dr. Shipko’s Informed Consent for SSRI Antidepressants.”

    Ah, so Shipco actually has a product to sell e.g. at Amazon.com at 4.75 for only 28 pages. Is that the motivation? I actually thought he was so motivated for helping people that this info would be on a website, for free. But this is the highest price per page I have seen in a long time on Amazon.

    It is the first book that gives warnings for patients who are considering stopping SSRIs as well as those who are considering starting SSRIs. The book is short and readable and does mention that the drugs can be very helpful for some patients. Most books on the topic are completely negative about using these drugs, and the bias is off-putting for patients who are trying to make their own decision about taking SSRIs.

    I would hope that patients find the eBook palatable and reasonably objective. Patients in my practice find the book helpful, and when a patient is still interested in an SSRI even after reading the book, I take this as a serious indication of how much they are suffering, and may find that the risk/benefit ratio tilts in favor of trying an SSRI.

    Risk/benefit? Even according to Pharma sponsored research the placebo reaches the same level as the drug only 3 days later. Star* D found that only 3% were helped after one year, and Kirsch found them no better than active placebo, with no clinical benefit over inactive placebo.

  • Analysis part 10
    If tardive dyskinesia is any guide, sometimes TD does go away, and sometimes it persists indefinitely. I expect that the same is true for SSRI withdrawal. The incidence of the late-onset and longer-term symptoms is not known because there has been no systematic study of the problem.

    Again, a totally spurious link to TD, no research. If you don’t know, don’t scare people and take away their hope because a few seem to not get better.

    Absent a meaningful treatment for the withdrawal emergent symptoms, proper informed consent before starting OR stopping the SSRIs is critical.

    Who says there is no meaningful treatment! Thousands have got a new life by stopping. Have a look at Monica’s and Altodtrada’s sites!

    Nobody should take SSRI antidepressants unless they know exactly what they are getting into. Informed consent for the SSRIs must necessarily include information concerning the difficulties related to stopping the drugs as well as the symptoms that occur when starting the drugs.

    Agree 100%, but difficulty does not mean impossibility.

    Also, patients who are considering stopping the drugs must also have informed consent concerning possible difficulties.

    Yes, but there is a big risk for nocebo effects.

  • Analysis part 9
    A quote from another post here: “Phil followed his doctors weaning recommendation, which was a very rapid wean for his years of Prozac use. His situation didn’t have to be so dire, and he knew this when he started the filming. He was warned by many,myself included, to not use that weaning schedule, it was destined for failure.” The trailer shows him optimistically cutting down with 50%. This is destined for failure for most, but sadly typical for being “assisted by a medical professional”. So if this is what Shipko uses as his guide/knowledge base, we have to doubt most of what he is stating in this post.

    Quick taper is very dangerous for most, including risk for suicide!!!, and many may have had this through rapid medication changes in the typical trial and error methods of psychiatry.

    Those who are on self-help websites want to believe that if they wait long enough (however disabled they may be in the meantime) that they will get better. The people that I have seen, suffering and disabled, waiting years for the ‘withdrawal’ to end are heartbreaking – particularly when they may be waiting for something that is not going to end.
    “Those who are on self-help websites want to believe”. This is tarring a lot of people with a very negative brush:. Gullible people with unrealistic hope. The human experience is so multidimensional that there is guaranteed to be a positive change in some areas (see Monica’s story) and others that stay relatively unchanged. Life is like that. It is not static. There are ups and downs in thousands of domains of experience.

    I don’t think Shipko wants to take away people’s hope, but he does this very powerfully here with an overconfident language , based on nothing but his very selective practice.

    And hope is the main ingredient I healing, so he is very wrong in messing with our hope on the basis of no research whatsoever.

  • Analysis part 8
    The difficulties that occur when patients stop SSRIs, particularly after 5 or more years on the drug, have not been fully acknowledged by physicians and citizen scientists alike. In my experience stopping SSRIs after 5 years of cumulative exposure can be risky, and I am not advising anyone who has taken the drugs for 10 years or more to try to stop unless they are willing to risk disabling symptoms

    No references, no research, arbitrary cutoffs and power language of “I am not advising anyone”. Even with Tardive dyskinesia with a 3% risk (well researched) per year, the majority will not get it even after 10 years of treatment. So would that merit taking the hope away from the 70% who will not have the problem? Breggin does not hesitate: he gives hope!

    The documentary movie, “Numb” by Phil Lawrence shows what can happen when a person taking Paxil for a decade tries to stop the drug. I’m sure that there are some people who can stop SSRIs after taking them for long periods of time, but prior to making such a decision, people are entitled to have a good idea of what can happen to them.

  • Analysis part 7
    L-tryptophan boosts serotonin in the central nervous system, but has not benefitted my patients. Some websites advertise supplements that increase glutathione, a liver detoxifier, as an antidote. SAM-e increases glutathione, and has not proven to be particularly helpful. SAM-e also increases neurotransmitter synthesis, and even when taken with L-tryptophan, does not seem to make much difference. Benzodiazepines seem to offer some relief, but they are dependency-forming and if taken regularly result in another dependency – although this is worth it for some patients.

    A lot of medical jargon, straight down biomedical model thinking, culminating in suggestion of benzos. He might as well have included cannabis, alcohol, cocaine and heroine. They have all been used as legal antidotes in earlier times.

    Not only do some patients stopping SSRIs develop a variant of tardive akathisia, a percentage of the patients who develop this problem will find that reinstating the SSRI will not alleviate the problem and may actually make the problem worse.

    Dr Breggin who has probably seen more hopeless cases than Shipko, but has a more positive non-biological attitude, states the exact opposite.
    Still Shipko is operating with “some” and “a percentage” with absolutely no reference to research or even concrete numbers from his own selective practice. There is absolutely no reason to believe the this is relevant for more than maybe 1 in 10 000.

  • Analysis part 6
    Tapering the drug slowly definitely minimizes the acute symptoms that occur when stopping an SSRI but does not appear (IMHO) to have much bearing on the longer-term and late-onset symptoms that occur when stopping an SSRI.

    At least he states “in my humble/honest opinion (IMHO)”. But the statement seems very absolutist, even if it is presented as just an opinion, as something that “appears to”. To someone who is afraid of reading just this, the cautionary words are going to drown and the hopeless message is remembered. A psychiatrist should know that this kind of communication style is dangerous especially for people who have problems with anxiety and depression.

    I have not found a meaningful antidote to the longer-term symptoms.
    “antidote” : biomedical model again. I cure sever anxiety every day without any form of biological antidote, and I don’t expect to find one either. Then I would have to subscribe to the biomedical model.

    In the search for antidotes, he then comes up with only 2(!!) chemicals, and that’s it. There are so many things that could be tried, it is ridiculous to give up after trying actually only L-tryptophan and SAM-e, before resorting to benzos. Look at all of Monica’s posts on Beyondmeds.com to get hundreds of ideas.

  • Analysis part 5
    They developed “fairly acute profound states of anxiety and or depression”. Can some (probably 1 in 10 000) people spontaneously develop these states and contact a doctor for it? Of course, that is what brought them to treatment in the first place. They have plenty of cues in the environment from earlier episodes that can trigger such reactions.

    Dr S. creates a strong and dangerous nocebo effect by implying that when things go well for many months, you can expect the worst. Many of us already have this too good to be true thinking pattern unnecessarily in our head and may destroy our best moments with it.

    Is there anything to link these strong reactions with the SSRI? Not really, unless you have a strong biological explanatory model for psychological suffering. This is the danger with Shiopko’s reasoning. It is as much biomedical model as the worst chemical imbalance theories. And he has absolutely no research, just a hunch that it must be the biological imbalance created by the SSRI.

    Because people are thinking of the discontinuation problem as withdrawal, they are not considering the later onset symptoms as related to stopping the drugs. What is somewhat frightening to consider is that patients with tardive dyskinesia sometimes do not manifest symptoms for years after stopping antipsychotics. Will this be the fate of those who stop SSRIs? This won’t be known for a long time, particularly if nobody is doing careful research on the topic.

    So, it is not known, these are just opinions!

  • Analysis part 4
    It is generally unappreciated that people who stop SSRIs often develop a new onset of severe depression or anxiety months after stopping the drugs.

    Often? How often. It is “unappreciated”, which must mean that it is maybe only Shipko who “appreciates this.

    It took me years before I realized that this is what was occurring, but this seems to be fairly common. Patients often did well for months, only to develop fairly acute profound states of anxiety and or depression.
    “seems to be”, no numbers, no references.
    “before I realized that this is what was occurring”. The presupposition (what needs to be true for the sentence to make sense) is that this is happening. Dr S just realized a fact.
    “Fairly common” can mean anything. If Dr S. gets sought out because of his e-book, most of his patients will have this problem, even if the rate is 1 in 10 000.

    The anxiety and/or depression was not a relapse, because the patients never had these symptoms before starting the drugs.
    Dr S. confidently states: “was not a relapse”. How can he know? Just because patients did not remember that they had these symptoms, or because they said so to be sure to capture the interest of dr S? The point is that there are so many subjective factors, including Dr. S remembering more easily things that fit his theory, that we have to do research, and cannot say anything definitive based on one man’s clinical subjective experiences.

  • Analysis part 3
    My clinical observation is that long lasting symptoms occur even in patients who taper very slowly, not just those who stop quickly, and that there is no guarantee that these symptoms will go away no matter how long the patient waits.

    Clinical experience with a very select population, but presenting it as general truths without having a shred of statistics to back it up. Monica and alto have thousands of successful cases.

    What I have observed is that the ‘withdrawal’ symptoms occur while patients are on a steady dosage of the drug, shortly after stopping the drug and weeks or months after stopping the drugs.
    Personal observations of one man, no studies, no references.

    The only precedent for this type of presentation is tardive dyskinesia (TD). Tardive refers to symptoms that occur later and dyskinesia refers to movement disorder.

    There is no reason to link these observed symptoms to td. Td is very well documented as an effect of antipsychotics use, and therefore it may seem that the shipko effect is well researched and established as well. It is still just his observations of some patients i a very select group of the sickest patient. We may easily be talking about 1 in 1000 patients or 1 in 100 000. In a big city he could have his whole practice filled with such patients even if only 1 in 100 000 get it.

    TD is generally associated with antipsychotic medication, and is also a manufacturer labeled side effect of the SSRIs. TD occurs while on antipsychotics, primarily occurs shortly after stopping them, and may occur months or even longer after stopping the drugs. With the SSRIs, it is not so much a tardive movement disorder as a tardive problem with akathisia, a sort of constant restlessness or agitation that is accompanied by an agitated anxious/depressed state. It is a very uncomfortable sensation.

    Again; no research, no references. Just words associated with suffering and claimed to be chronic

  • Analysis of Shipko’s pessimism part 2
    Outside of using a benzodiazepine, I don’t have a lot of suggestions.

    This also seems quite pessimistic and unimaginative. Go to Monica’s site to find hundreds of suggestions and encouragements to what can be done. Mentioning benzos as a solution gives a strange effect since most users of mia would think benzos are worse than ssri. So mentioning this as the only hope, creates a double hopelessness.

    Reinstating the medications often does not help and sometimes there is a negative reaction.

    According to Breggin, this is absolutely not the case. For the vast majority reinstating the dose works wonders. But shipco may create much fear and nocebo (negative placebo) effect with this statement. Such unfounded absulutist negative statements are very dangerous.

    In the past I worked with SAM-e, thought to enhance neurotransmitter synthesis, and L-tryptophan, a precursor of serotonin. It had placebo value, but was not an ‘antidote’ to the problem.

    Some MD jargon to give the impression that Dr S. is an expert and has tried everything. It is not very inventive and persistent to try just two things.

    Citizen scientists developed a set of corollary beliefs; primarily that the protracted withdrawal is largely due to stopping the drug too fast and that if one waits long enough that the symptoms of protracted withdrawal are going to go away.

    Shipko claims to not use Citizen scientists in a negative way, but here he claims that they have “corollary beliefs,” (in many ways worse than “beliefs”, because they are just results of other beliefs) while he has “observations”. Subtle power language.

  • Apart from the clear advertising for his overpriced “book”, I think Shipko probably is a well meaning, enthusiastic and compassionate man, but this post is negative and hope-destroying, full of opinions and totally lacking any scientific basis.

    I started analyzing it for myself because it affected me. And I am a very optimistic clinical psychologist, I should not be influenced by such baseless opinions. But Shipko’s communication style is so overpowering that I was affected. So I will publish this analysis here to help others not lose hope because of things that may happen to only 1 in 10 000 patients. Shipko has no research to refer to, so he should have stayed quiet. My comments are in bold. I publish in seeral parts to avoid the 2000 characters “read more”limit.

    If I thought that it was possible, I would have opened a string of clinics all over the country to help get people off of antidepressants.

    Here starts the pessimism. Why shouldn’t this be possible? We have hospitals that have patients actually dying, but we don’t stop having hospitals because a few cannot be helped. By starting with this statement, Dr S builds a case for not having hope.

    Unfortunately, the problems that sometimes occur when people try to stop an SSRI antidepressant are much more severe and long-lasting than the medical profession acknowledges, and there is no antidote to these problems.

    Even if he uses the word “sometimes occur” they are drowned out by the absolutist (and with no scientific backing) words “no antidote to these problems”.

  • Dr Shipco,
    Do you have any research to support this? It seems overly pessimistic. I have stopped several patients with SSRI, and they are very happy about it. I have actually toyed with the idea of starting a big clinic for withdrawal. Dr. Breggin seems to not support your pessimistic view.

    The big danger is that with this article you may create a big unnecessary of nocebo effect.

  • Become cyber activists! There are so many good writers with much knowledge and experience in MIA, but sometimes I feel it is wasted on people who have good attitudes already, in other words, you are preaching to the choir. All these good comments should be put on sites read by people who normally don’t come to MIA, like the Guardian, New York Times etc. That’s where we can make a difference. And we may always refer readers to MIA! One tip: Google e.g. on “antidepressants comments” and choose setting “within last 24 hours”. Then you will have the opportunity to reply to people who have no idea about all the positive things MIA readers already know about. This will really be useful activism that may reach millions.

  • Become cyber activists! There are so many good writers with much knowledge and experience in MIA, but sometimes I feel it is wasted on people who have good attitudes already, in other words, you are preaching to the choir. All these good comments should be put on sites read by people who normally don’t come to MIA, like the Guardian, New York Times etc. That’s where we can make a difference. And we may always refer readers to MIA! One tip: Google e.g. on “antidepressants comments” and choose setting “within last 24 hours”. Then you will have the opportunity to reply to people who have no idea about all the positive things MIA readers already know about. This will really be useful activism that may reach millions.

  • Finally the one at the top of the world’s leading research organization admits that the underpinning of almost all psychiatric research to date is invalid. If the diagnostic categories on which all the research is based are invalid, and also not reliable (as the field trials for DSM V showed), we will have to throw it all out and cannot trust any of its claims. It is as if Insel is saying to the profession: unless you can prove that bloodletting is curing something you can really objectively measure, you have to stop it.
    So since it is impossible to show objectively e.g. that Zyprexa has an effect on anything since psychotic symptoms are not observable in the sense Insel insists, we cannot continue using this medication against socalled schizophrenia.
    Insel wants to go for genetics and imaging. Genetics has been promising results right around the corner for 40 years and still not found anything that has been replicated. Imaging is at such a simple stage that the smallest unit of measure is approximately 1 cubic millimeter. In this cubic millimeter there will be approximately 1 000 000 000 neural connections that will continuously evolve and program themselves based on input to the brain. In other words: When we see the activity of this network it shows up as only one pixel of MRI. A network this size has the complexity the connections between all the computers on the internet. And this shows up as only one pixel among at least 1 000 000 pixels. So it is clearly an impossible task with todays technology to even come close to understanding the complexity of even one cubic millimeter of the brain since the whole network shows up as only one pixel.
    For the sake of argument though, we could imagine that we could scan all of the 1 000 000 000 connections, know the exact electrical state, which by the way is not a one or zero like in a computer, but varying continuously so as to produce millions of possible voltages for each connection. Add in a few hundred different neurotransmitters at various concentrations, and one has recorded the state of the system. In the next millisecond the whole system has changed and we have to mearure it all again and try to make sense of why it changed, and what we can do with it to change in a better way.
    But let us imagine that we could follow all these changes in all these connections. Would we be any wiser by knowing all this biological data? How would we find the program of this circuit, especially since every cubic millimeter of every human would be different due to the different input each individual has had. Clearly impossible.
    But if it proves to be possible, would we be able to help the patient biologically? Would we send in nanorobots to rebuild a better micro network unique to each patient? And how would we rewire these extremely complex systems? Clearly impossible!
    So Insel has embarked on a quest that could clearly be termed “mission impossible”.
    But is there an alternative?
    Yes, actually. We are dealing with a very responsive intelligent self programming system, that is designed to be programmed by its inputs. The brain gets input through all sensory systems and automatically learns complex tasks such as language and motor movements. So we already have a relatively simple input system. We also have an output system in the form of speech, movements etc. So with some experimentation with varying input, mostly in the form of language, but also tailored experience, we can reprogram the system. This has actually been done. It is called psychology.
    I am a clinical psychologist, and I experiment on a daily basis with these unique brain systems in the form of psychotherapy, more specifically cognitive behavioral therapy. The basis for this kind of research was laid in the 1950s by BF Skinner. He took the stance that we may only observe the input to the system (human with its brain) and the output. We could not know the intricate patterns within the brain. Insel seems to think we know, although we are not in any way able to see the 1000 000 000 connections in the MRI pixel.
    From an information processing point of view, Skinner was on the right track. By experimenting with input and watching output (language and behavior) in more and more complex ways, millions of suffering human beings have been helped by what may be termed psychological reprogramming through therapy. This morning I had the pleasure of doing follow up on a young woman who for years had been tormented by horror film images that she could not get out of her head. Three months ago I had taught her a technique that she could use to take control over these images. I had told her that she could imagine the horrible picture/film clip right in front of her, send it away at high speed, all the way to the mountains, and then taking in a picture of herself smiling broadly because she was not plagued by the images again. This image would rush in from the mountains in less than a second and stop right in front of her. She had repeated this technique 5 times with a half minute break between each.
    Since that moment, the images had not bothered her at all. She was already on an antidepressant when she came to treatment. It had not helped. But the reprogramming did the trick in approximately 5 minutes. 10 years of suffering disappeared by using a simple technique. Other patients need more time consuming reprogramming in the form of exposing themselves for what they are afraid of, repeatedly over several weeks. OCD symptoms such as fear of germs and compulsive washing, is often easily treated like this. Years of suffering is reversed in a few weeks of retraining the brain. Depressed patients are trained to interpret their input (words from others, looks) in more positive ways than what they used to, and the result is side-effect free relief from depression, which often has positive effects on other areas of functioning such as relationships and sex, quite to the contrary of antidepressants.
    So by changing the input (techniques, retraining, restructuring of thinking patterns) one has been able to change the output of the brain. And one does not need diagnosis to do this. It is totally uninformative for me to know the diagnosis of the young woman. At best it will just make me have a stereotypical, usually pessimistic , reaction to her (“Oh here comes another borderliner, they are so difficult to treat”). I asked her what her problem was, and we reprogrammed that specific problem. She was also a perfect example of the self-reprogramming capacity of the human brain. Today she told me that she had rented a horror movie just to revel in how “finished” she was with the problem of scary images getting stuck, and she discovered that she had also got rid of strong reactions she used to have regarding crawling insects and maggots.
    We also discussed another problem she gets from time to time: she starts thinking of a negative possibility and then creates long chains of worry thoughts based on this, often ending up as loveless and homeless. I challenged her to catch the first negative thought, and then to use her intelligence and creativity to find what could be positive in the original negative thought. One thought was “I may do something wrong in my job and be fired”. She thought it strange to find something positive in that, but after less than a minute, she smiled and said: “Well I will get to try something new, get rid of my irritating colleagues, maybe get an opportunity for a new career”.
    Some of these suggestions may be far-fetched, but training the brain to make them, changes the circuits and increases the probability that more positive thoughts will block the negative rumination in the future.
    So every day as a clinical psychologist, I see the miracle of the programmable human brain. I find the specific problem, (what we would call case formulation) give the right input, start the right training, and the brain changes. Sometimes is almost too easy. A middle aged woman had been plagued by the thought of rats for several years. Several times a day, the words “rats” popped into her brain, and made her get scary rat images. I just told her to practice saying the sequence:” rats-stop-I am working on my anxiety and getting better!” (in a positive tonality). So she did, and the next day her 3 good things per day diary (another very good technique) reflected that she was no longer plagued by the intrusive thoughts of rats. Very specific problem, very specific retraining, and brilliant, quick result.
    Commanding auditive hallucinations that ask the person to do violent things, are often considered to be the worst of the worst of psychiatric symptoms. A woman in her fifties, taking a cocktail of 5 different antipsychotics, suddenly hallucinated a male voice saying “go and hang yourself, you pig”, over and over again. She told me about it and was extremely distressed, ready to do what the voice said, just to get it to stop. I told her: “repeat what the voice says to you, and then you say quickly in an upbeat voice: “No! I want to live”. This was a mix of exposure training, symptom prescription to take control , and classical conditioning to make the negative voice trigger her own positive thought. Within two days the negative voice had disappeared. So a simple retraining/reprogramming of a very specific symptom created a very specific relief, which also gave her a general confidence that she could handle any hallucination, and took away her fear of madness.
    So Insel may be right in one thing: we need to look at specific problems and find specific solutions. His error is to search for the solution in the wrong place, biology. Brains are programmable computers so we should try to program them! It even responds to natural language commands and can do complex self reprogramming in seconds.
    Insel is like the curious kid who tries to take the computer apart, piece by piece to try to find the nice woman in the YouTube video, or to take away the offensive remarks in the blog about him. He discovers he can take the offensive remarks away by short-circuiting the motherboard (ECT) or by injecting it with acid (medication) but destroys the computer in the process.
    The more intelligent approach to a programmable system is to re-program it! Then the nice YouTube picture could be printed, enlarged, sharpened, inserted in another picture etc. The offensive language in the blog could automatically be blocked by some simple programming statements.

    So Insel got two thirds right:
    1. Psychiatric diagnosis have no biological basis ( in other words, there is no biologically diseased brain), no validity and hardly reliability.
    2. It is better to focus on smaller units of distress, particular problems.
    3. But the solution is not in biology. Stop short circuiting the computer or flooding it with chemicals. Start programming our brains with natural language cognitive behavioral therapy.

  • It seems great that companies are fined, but for them it is just the cost of doing business. They will recover their losses by increasing the price of their drugs, so who pays in the end? Taxpayers and patients. Personal jail time would be the deterrent. One executive got 30 days because the pills were too big! Seems like with a bit of creativity it should be possible to get an executive for manslaughter.

  • “Atypical antipsychotics can be lifesaving for people who have schizophrenia, bipolar disorder or severe depression”. How about premature death, 25 years earlier, due to metabolic syndrome. How about a 10 fold increase in suicide in schizophrenics after the socalled antipsychotics came on the market. Maybe they should be called antipsychotics for a new reason: they get rid of the psychotics!

  • With any other medication, and increased risk like this would result in pulling the products from the market. With antidepressants the risk for death in older patients is substantial. From a blog by paul Andrewa et al. on this site :
    “In the study published in the British Medical Journal, antidepressants were estimated to cause 10 to 44 deaths out of a 1000 people over a year, depending on the type of antidepressant. In comparison, the painkiller Vioxx was taken off the market in the face of evidence that it caused 7 cardiac events out of 1000 people over a year. Since cardiac events are not necessarily fatal, the number of deaths estimated to be caused by antidepressants is arguably of much greater concern.” https://www.madinamerica.com/2012/09/things-your-doctor-should-tell-you-about-antidepressants/#comments.

    Why is nothing done to forbid marketing of these products?

  • I started working in a mental hospital after haveing done private practice for 12 years. Cognitive therapy worked marvels for most of my patients in private practice. The only patients who seemed to not get better were the medicated ones. In the mental hospital I saw the same trend. I started wondering if the drugs actually made them worse, and I actually thought i was getting deluded. Was I the only one who had such a heretical thought. After I left the mental hospital and started private practice again, I stumbled upon Peter Breggin’s book “Toxic Psychiatry” and all the pieces of the puzzle fell into place. I realized that most of the suicides I had witnessed had been after abrupt medication changes, that most of the bipolar patients had turned manic on antidepressants, and that many of the anxiety patients that were difficult to cure with cognitive therapy were actually suffering from akathesia.I still remember how we psychologists “bought” the psychiatrists explanation of how the SSRIs were like fertilizers for the brain. I was happy to write my notes with a Zyprexa pen, and have free lunches sponsored by Lilly. Knowing what I know now, I would have been disgusted to write anything with it.
    After my eyes were opened I have seen the typical cases where patients become very akathesic from zoloft and zyprexa, try to commit suicide, have to be restrained etc. One patient finally got so constipated from antidepressants that she had to be admitted in the gastro department. They stopped the antidepressants, and she never had to be restrain again. Another ripped of flakes of skin on her arms until we stopped her Effexor, then all the extreme anxiety symptoms went away.

    Even with strong demonstrations like this, it is very difficult to get doctors to change their minds. They insist that these medications save lives. Cognitive dissonance prevents them from seeing their errors. They would not be able to sleep at night if they knew of all the patients they had destroyed. They have to continue believing in the medications to save their sanity!!

  • I so agree with you Anonymous. I used to be inside the system as a clinical psychologist, and I used to believe what the psychiatrists told us, that the medication was needed, often for life.

    It is so catastrophic that we now see that the very medication that is seen as so essential, now destroys the brains, without having a single long term study to prove anything but deterioration.

    I am ashamed of my profession, that we psychologists have done so little to oppose the psychiatrists. And I am so outraged over the psychiatrists who continue this mass destruction of people’s brains.

    No medical treatment, even from ancient times days even come close to the damage antipsychotics do now. And to think that people now take them as augmentors for depression treatment and as mood stabilizors! The best selling medication in America, that is a prime example of mass delusion!

    Well, you will be very stable when you have no brain left! This brings a whole new meaning to the word “shrink”

  • It may all be a result of what Anatomy of and Epidemic is all about: IATROGENIC DISTURBANCES. An estimated 3% pr. year of people taking anti psychotics will develop tardive psychosis, as well as 5% who will develop Tardive Dyskinesia pr year, (see Bregging.com for several references).

    Since many children are now given anti psychotics for their supposed bipolar disorder, it is no surprise that we end up with higher rates of diagnosed Schizophrenia.

    There is of course also the possibility of doctors wanting to diagnose schizophrenia early, if they believe that it is essential to reduce Time of untreated psychosis, and in addition believe that this is a degenerative disorder that can be slowed down by drugs.

    This article may point to exactly how dangerous the belief system that doctors have may be to a whole population.

  • I have mad a video comment at
    http://www.youtube.com/watch?v=WbRz5PUn8xA&feature=plcp

    Summary:
    Is it possible to think positively about our psychological problems?
    Cognitive therapy: your reactions are a result of how you think of your problems.
    If you can think positively about e.g. psychotic experiences, it is a good for your psychological health.
    Normalizing: works very well for all psychological problems
    See that the process is a part of normality, just maybe a bit extreme.
    E.g. Paranoia: If not too extreme, protects us and our children.
    The nocebo effect: as powerful as placebo
    Believe that you have a degenerative brain disorder, and it will make you sicker.
    Conclusion: you have all reason to think positively about you psychological problems

  • It is possible that the medical model of mental illness does exactly the opposite of what its proponents proponents claim. The biological model may take away some blame from parents and caregivers, but it can have a very different effect on the patient, not only when it comes to shame, but also maybe even more when it comes to hope.

    If you have been told that you have a broken brain and you search on the Internet about the prognosis, you may find that this is a so-called neuro-degenerative disease and that you will have to take medications for the rest of your life.

    Then you see that these medications rob you from the little life you had. Of course you lose hope, and of course you can feel ashamed that you have a brain that is different from other peoples brains, that you cannot function, and that this is in your biology.

    So you cannot do anything about it, apart from taking medications that make you even worse in many ways: fat, sluggish, cognitively impaired, with a lot of other side effects. Of course, you would have to be in extremely good psychological health to not lose all hope!

  • I quite agree. 5% chance of tardive dyskinesia for every year of treatment, 3% risk for tardive psychosis for each year, cognitive decline, diabetes, heart disease.
    Keep him drugged for 10 years, and he will really come out a “changed person”.
    Forced treatment is really much worse than prison, specially Norwegian luxury prisons with internet and TV in every room, free education and all expenses paid, even trips to the cinema.

  • This is a very interesting observation! Could it be an artifact of the trial design? When people start a trial on antipsychotics they are usually on another antipsychotic. They have to go abruptly off their previous medications while they are thinking that they’re getting the new medication in the so-called placebo washout trial, usually for 2 weeks. Then the real trial starts and excremental group gets the real drug and the control group continues on placebo.

    The experimental group will of course get many side effects that may be visible to the researchers, but it may be that the placebo group nowadays, as they are probably coming off second-generation anti psychotics have so many withdrawal effects that it is more difficult for researchers to guess who is in the experimental group and who is in the control group.

    In this way it’s not that easy for them to break the blind as they might have done in the past, guessing on the basis of side effects.

    So maybe this is just a testimony to how withdrawal effects of the second-generation anti psychotics may be much worse than withdrawal effects from first-generation anti psychotics. The researchers are not able to break the blind, they think a patient in the placebo group has got the “real stuff” , and since they are paid by the manufacturer, they will consciously or unconsciously score this person as more improved than if they thought the patient had got placebo.