Thursday, February 27, 2020

Comments by Altostrata

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  • This is terrible. I don’t know if we would have been able to help Zel Dolinsky, but on SurvivingAntidepressants.org we have a protocol to taper polypharmacy and routinely help people go off their drug cocktails. It’s not easy and it can take a long time, but it can be done. (FYI, an outline of the protocol is here https://www.survivingantidepressants.org/topic/2207-taking-multiple-psych-drugs-which-drug-to-taper-first/)

    When grueling symptoms such as akathisia and sleeplessness have already set in, maneuvering is more limited — but we do have people who have recovered from this.

    If I, a peer counselor with no formal medical background, can figure it out, a smart doctor could do it. I hope in the not-to-distant future, many will.

    Sadly, although huge numbers are being overmedicated with all kinds of drugs, we’re still in the era where adverse drug reactions are considered very rare, with very little clinical training to deal with them. It is a failure in medical practice that so many patients cannot find a doctor with even a particle of understanding about drug adverse effects. They simply do not want to get entangled in this, especially when psychiatric drugs and purported “mental illness” are involved.

    Even psychiatrists will shrug at adverse drug effects and mumble something about “but the drugs do so much good!” or some such irrelevancy.

    This is perhaps the cut that hurts worse — feeling abandoned by medicine — left out on the ice floe, as it seems.

  • Very glad your son is doing better. All your other assertions are false, I have zero to do with big pharma.

    Simply because Alt to Meds Center is “anti-pharma” (not entirely true, they have a physician consultant to prescribe drugs) does not mean it offers effective treatment or presents its services in an ethical way.

    I have personal experience with Alt to Meds Center, I have several other reports from those who have found their services unsatisfactory, and I do not recommend Alt to Meds Center for drug tapering or recovery from withdrawal syndrome.

    MadinAmerica.com should not have published an article commissioned by Alt to Meds Center as an unbiased report. That it was offered to MIA without disclosure that it is an infomercial is an indication of the kind of sales tactics used by Alt to Meds Center.

  • I actually did personally witness and participate in the integral structure of the ATMC protocol and program. I know it very well.

    The so-called statistics and scienciness cited in praise of ATMC are hooey, as it your argument. What is your relationship to ATMC and Dr. Corrigan?

    Some alternative treatments are worthwhile and some make claims for themselves far beyond reason. As a peer advocate with many years of expertise in psychiatric drug tapering and withdrawal, I do not recommend Alternative to Meds Center for this purpose.

    Still want to caution MadinAmerica.com against publishing infomercials for alternative treatment and supplement programs preying on the fear and desperation of those injured by psychiatric drugs and looking for a way off them.

  • I’m very sorry, Dr. Corrigan’s article is an infomercial, probably paid for by ATMC, and MadinAmerica.com should never have published it.

    I’m glad Ryan is doing much better.

    It’s very possible individuals have gone to ATMC and benefited from it. Personal testimonials, while compelling, do not indicate quality of care. Any one testimonial might be counterbalanced by 100 who felt they had been misled, which do not happen to be published here.

    I run a Web site providing peer support for psychiatric tapering and withdrawal. I have had extensive personal experience with ATMC. Several members of my Web site have had personal experience with ATMC and reported it on my site.

    If I had confidence in ATMC and its claims, I would refer people to it all the time. I do not recommend or refer people to ATMC.

  • Hi, Bob. Don’t get me started about the New Yorker article. I, too, expected it to be a tipping point and was very disappointed. As everyone knows, I run the peer support site for tapering off psychiatric drugs, SurvivingAntidepressants.org, which was mentioned a couple of times in the article.

    (The following remarks are about how Laura is represented in the story as a character, not the real Laura Delano, who, as Bob points out, has a somewhat different story.)

    Reading without benefit of Laura’s backstory (which we know from MIA), I perceive Rachel Aviv’s story as written to be one of psychiatric overdrugging, polypharmacy, and potential misdiagnosis. While numerous psychiatric experts probably associated with Harvard (crux of biological psychiatry) were involved in a long trail of mistreatment, I believe psychiatrists will view Laura’s case as an outlier.

    The article failed to convey how common psychiatric misdiagnosis, overdrugging, etc. is. It also glossed over how Laura came off the drugs, and since she had also overdosed and suffered from rhabdomyolysis, psychiatrists will attribute the cursory description of her post-withdrawal symptoms to that. So no game-changing there.

    The general reader may be appalled by the description of prescription cascade, polypharmacy, and adverse effects, but not get the very important point: ANYONE can be taking even one psychiatric drug, have trouble coming off, and meet nothing but misdiagnosis and mistreatment of adverse reactions, particularly withdrawal symptoms.

    The writer, Rachel Aviv, deliberately misrepresented the topic to me as a long, in-depth article about online peer support for coming off psychiatric drugs. (Beyond my site and Laura’s The Withdrawal Project, which shares much content with my site, there is an extensive peer support network serving hundreds of thousands if not millions of people.)

    I perceived a New Yorker article about this could be a game-changer for finally handing off psychiatric drug tapering to physicians, where it belongs. Consequently, I spent many hours corresponding with Aviv, sending her dozens of journal articles, in which she seemed very interested. We went back and forth in congenial discussion about deep underlying controversies in psychiatry. She ended up quoting several of my sources.

    Aviv knows the ground, but produced a rather superficial human interest story not much different from other psychiatric drug horror stories published in the New York Times, the Daily Mail, and elsewhere.

    I also saw signs of stuff chopped out and awkward transitions. We should all have known better — issues in psychiatry flummoxed Louis Menand, an otherwise excellent writer, in a February, 2010 New Yorker article.

    Not a tipping point, not a game-changer, just another one-off human interest story, and attenuated, as you point out, by unnecessary cant about the benefits of the drugs.

    For the Web, the article was originally titled the clickbaity The Challenge of Going off Antidepressants — completely inappropriate, as Laura was taking a basket of psychiatric drugs other than antidepressants — if that tells you anything.

    After the article was published, I expressed my disappointment to Rachel Aviv, who admitted she is also writing a book.

    This whole experience has certainly changed my view of the New Yorker’s credibility.

    PS I am now even more determined to transfer responsibility for getting people off psychiatric drugs to the professional medical community and put myself out of business. I am tweeting as @Altostrata with hashtag #Deprescribing.

  • Curiously, Andrew Solomon’s first episode of “agitated depression” was also misdiagnosed benzodiazepine withdrawal syndrome. Coming from a family fortune from the pharmaceutical industry, he was convinced that he needed serious psychiatric drug treatment. He went through years of antidepressant switches and more adverse reactions — no doubt also misdiagnosed as psychiatric symptoms — and now claims to be in a drug-balanced state.

    He’s been preaching about the need to treat depression and the effectiveness of antidepressants ever since. Of course, he did delve into his history and found good reason for psychiatric disorder — very few among us do not have this!

    His journey into psychiatric drugs is recounted in an article he wrote for the January 4, 1998 New Yorker, Anatomy of Melancholy https://www.newyorker.com/magazine/1998/01/12/anatomy-of-melancholy

    David Foster Wallace experienced years of misdiagnosed Nardil withdrawal syndrome. He experienced round after round of additional psychiatric drugs. He was convinced the drugs were making him worse. Did he kill himself because he thought he had an incurable psychiatric condition?

    These circumstances are contained in a February 28, 2009 New Yorker piece by D.T. Max https://www.newyorker.com/magazine/2009/03/09/the-unfinished

    “….In the late eighties, doctors had prescribed Nardil for Wallace’s depression. Nardil, an antidepressant developed in the late fifties, is a monoamine oxidase inhibitor that is rarely given for long periods of time, because of its side effects, which include low blood pressure and bloating. Nardil can also interact badly with many foods. One day in the spring of 2007, when Wallace was feeling stymied by the Long Thing, he ate at a Persian restaurant in Claremont, and afterward he went home ill. A doctor thought that Nardil might be responsible. For some time, Wallace had come to suspect that the drug was also interfering with his creative evolution. He worried that it muted his emotions, blocking the leap he was trying to make as a writer. He thought that removing the scrim of Nardil might help him see a way out of his creative impasse. Of course, as he recognized even then, maybe the drug wasn’t the problem; maybe he simply was distant, or maybe boredom was too hard a subject. He wondered if the novel was the right medium for what he was trying to say, and worried that he had lost the passion necessary to complete it.

    That summer, Wallace went off the antidepressant. He hoped to be as drug free as Don Gately, and as calm. Wallace would finish the Long Thing with a clean brain. He entered this new period of life with what Franzen calls “a sense of optimism and a sense of terrible fear.”….”

    D.T. Max later published a biography about Wallace with more detail.

    After going off Nardil, Wallace embarked on the kind of hell anyone who has experienced antidepressant withdrawal syndrome will recognize, replete with misdiagnosis, denial, and hypersensitivity to subsequent psychiatric drugs. Since he had a long psychiatric history and prior suicide attempts, his suicide is attributed to his pre-existing mental condition.

    In my experience, after reading thousands of reports from patients and collecting more than 6,000 longitudinal case histories of psychiatric drug tapering and withdrawal symptoms on my Web site Surviving Antidepressants http://survivingantidepressants.org/index.php?/forum/3-introductions-and-updates/ , physicians, including psychiatrists, generally do not recognize any psychiatric drug adverse effects and almost invariably misdiagnose withdrawal as relapse or emergence of a new, weird psychiatric disorder calling for high dosages of lots of drugs, which tend to make people worse.

    Clearly, there is a longstanding area of physician error in misdiagnosis of psychiatric drug adverse reactions and withdrawal symptoms and consequent patient harm. My belief is they think such adverse reactions are so rare, they’d never see them in their patients. They presume everything is a horse, not a zebra. Too bad we’re losing so many zebras.

  • One important question is what is meant by “depression” in each clinical trial or study. Does the patient base include people who are in distressing situations, such as bad marriages, bad jobs, or grieving? Such situational depression tends to resolve on its own within months and used to be excluded from the diagnosis of “major depressive disorder” (MDD). Now MDD can be diagnosed in a ham sandwich.

    For people with situational depression, a diagnosis of MDD might well convince them they have a permanent disease. Combined with drug side effects, they may well be impaired for a period beyond the normal course of recovery, while not experiencing much relief from the distress — they’re still in a situation that needs resolution. Pills rarely do this.

    In other news about psychiatric drug efficacy:

    Psychother Psychosom. 2019 Mar 20:1-9. doi: 10.1159/000496734. [Epub ahead of print]

    Withdrawal Confounding in Randomized Controlled Trials of Antipsychotic, Antidepressant, and Stimulant Drugs, 2000-2017.

    Récalt AM, Cohen D.

    Abstract at https://www.ncbi.nlm.nih.gov/pubmed/30893683

    BACKGROUND:
    Results of relapse prevention randomized controlled trials (RCTs) which discontinue psychotropic drug treatment from some participants may be confounded by drug withdrawal symptoms. We test for the confound by calculating whether ≥50% of the difference in relapse risk between drug-discontinued and drug-maintained groups is present at discontinuation time points (DCTs) with “short” and “long” assumptions regarding onset and duration of withdrawal symptoms.

    METHODS:
    In eligible RCTs of antidepressants, antipsychotics, and stimulants from 2000 to 2017 (n = 30) selected from a systematic review, differences in relapse risk were examined by arithmetic and graphical comparison of mean behavioral scores or survival plots.

    RESULTS:
    Only 14 studies (46.6%) with 15 analyses of relapse risk provided sufficient data. Under short and long DCTs, 9 of 13 (69.2%) and 7 of 9 (77.8%) interpretable analyses, respectively, suggested a withdrawal confound. The proportion of endpoint placebo-maintenance group difference present by the DCT averaged 69.1% (range, 58.7-148.0%, n = 13) for short DCT assumptions, and 79.0% (range, 51.5-183.3%, n = 9) under long DCTs. One study (3.33%) controlled for withdraw al effects, and 1 yielded inconclusive results.

    CONCLUSIONS:
    These results support suggestions that withdrawal symptoms confound the results of relapse prevention RCTs. Accounting for such symptoms in RCTs is an ethical, scientific, and clinical imperative. Justifications for relapse prevention RCTs employing a discontinuation procedure require more scrutiny.

    Given the razor-thin margins for significance in findings for psychiatric drug efficacy, the confounding of withdrawal symptoms for relapse may well tip all of these studies into findings of no significant efficacy for each drug.

  • This book is the most helpful guide I’ve found for tapering psychiatric drugs.

    If you have read Dr. Glenmullen’s The Antidepressant Solution (or, in the UK, Coming Off Antidepressants) and would like to suggest updates for a revision, please contact me at https://www.SurvivingAntidepressants.org/ (scroll down to bottom of page, click on Contact Us). Thank you.

  • Dr. Corrigan, please supply a full statement of your conflicts of interest regarding Alternative to Meds Center.

    Here is the report you provided https://www.alternativetomeds.com/wp-content/uploads/2019/01/ATMC_OutcomeStudy2018.pdf as Vice President, Multi-Dimensional Education Inc.

    More about your company here http://www.mdedinc.com/httpdocs/about_us

    Did ATMC commission you to do this study? Thank you.

  • I have personal experience with Alternative to Meds Center and in no way would call their approach evidence-based.

    Over months of volunteering, I found absolute ignorance of withdrawal symptoms and a great deal of overpromising in regards to their supplement regimens, which are based on orthomolecular principles of “balancing neurotransmitters.”

    There certainly is no evidence base for those orthomolecular regimens: The “neurotransmitter imbalance” theory has been thoroughly debunked in the rest of the world.

    Because of the supplements, clients are supposed to be able to go off multiple psychiatric drugs with minimal withdrawal issues within a very short stay. On my Web site, SurvivingAntidepressants.org, where we urge a gradual taper based on individual tolerance to dosage reductions — which can take many months — we have gotten reports of very bad outcomes at Alternative to Meds Center.

    Quick recovery from a fast taper is a tribute to individual nervous system resiliency, not a function of overpriced supplements.

    In addition, Alternative to Meds Center follows an addiction rehab model, which holds you have to suffer through withdrawal syndrome to break your dependency habit. This is inappropriate applied to psychiatric drugs (and, in my opinion, is counter-productive in going off addictive drugs).

    Essentially, ATMC is a basic addiction detox center with alternative medicine garnishes. If they addressed psychiatric drug tapering, your local drug detox program would provide the same services at lower cost (usually covered by health insurance) with about the same quality of care.

    There is a lot of gas-lighting, manipulation, and woo-waving at ATMC, which is a common pitfall in alternative treatments. I would not trust any of their internal data, much less testimonials or Yelp reviews.

    On paper, ATMC offers a very appealing model. If I could recommend it for psychiatric drug withdrawal, I would be happy to send everyone there, despite the high cost. Rather, on SurvivingAntidepressants.org, we make it clear that we do not recommend Alternative to Meds Center in Sedona, Arizona.

  • It is bizarre that a spotlight on a serious adverse effect of a class of drugs is cast as a war on the drugs themselves.

    The assumption that antidepressant withdrawal symptoms generally are mild, transitory, and last only a few weeks was promulgated in a pair of supplements to the Journal of Clinical Psychiatry in 1997 and 2006 arising from “expert” symposia sponsored by pharmaceutical manufacturers Lilly and Wyeth, respectively, and led by the notorious Dr. Alan Schatzberg.

    The conclusions of the “consensus panel” were based only on the opinions of the participants. There was no data or real evidence involved. No citations were given for the statements about the severity of withdrawal syndrome.

    These papers are buried in the citations of nearly all other medical literature about antidepressant withdrawal syndrome, with the erroneous assumptions circulated over and over until they calcified throughout psychiatry into “evidence.”

    To his credit, one of the experts from Schatzberg’s “consensus panel,” the UK’s Dr. Peter Haddad, repeatedly has made an effort to remedy this misinformation, authoring many papers about withdrawal syndrome and warning about its misdiagnosis. He has pointed out repeatedly that withdrawal symptoms may be relatively mild only in most cases — there are exceptions, the extent of which is unknown.

    As Dr. Haddad stated in 2001: “Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion.” (Haddad, P.M. Drug-Safety (2001) 24: 183. https://doi.org/10.2165/00002018-200124030-00003)

    I also had personal correspondence in 2006 with another member of the expert panel, Dr. Richard Shelton, who admitted to me that some individuals can suffer severe and prolonged withdrawal syndrome. (Like Dr. Schatzberg, Dr. Shelton went on to a lucrative career as a pharmaceutical company consultant.)

    The “experts” who presented their opinions as evidence informing medicine’s assumptions about psychiatric drug withdrawal are well aware they have not disclosed all the risks. Consequently, physicians everywhere have a false sense of safety about these drugs and are blind to the adverse effects.

    However, given the extremely high rate of psychiatric prescription, the expedient gloss over the potential of injury has caused damage to millions of people.

    In correspondence years ago with Dr. Haddad, he hinted that gathering case histories would be instructive in this debate. On my Web site, SurvivingAntidepressants.org, I have gathered almost 6,000 case histories of difficult psychiatric drug withdrawal, none of them mild, transient, and lasting a few weeks. You can see them here http://survivingantidepressants.org/index.php?/forum/3-introductions-and-updates/

    These case histories also demonstrate the many, many ways people are being misdiagnosed and misprescribed. Taken together, they’re a landscape of the pitfalls in medical knowledge regarding psychiatric drugs and their adverse effects.

    Another critic of the Read and Davies paper, Dr. Ronald Pies, recently contended in Psychiatric Times that psychiatrists know how to taper people slowly off drugs and therefore serious withdrawal syndrome as reported by Read and Davies is nearly non-existent.

    Dr. Pies’s claims are based solely on his own 2012 paper, in its prolix entirety at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/, in which he states:

    “In my own practice, I would typically “wean” a patient off a chronically administered antidepressant over a period of 3 to 6 months and sometimes longer. To my knowledge, this period of tapering has rarely, if ever, been used in existing studies of antidepressants or in routine clinical practice.”

    Dr. Pies knows very well that “proper psychiatric care” for tapering “managed appropriately” is virtually impossible for patients to find. This tends to confirm Read and Davies are on the right track. We need better ways to taper people off psychiatric drugs.

  • Of all the RCTs done on antidepressant efficacy and “discontinuation” studies purporting to demonstrate that people relapse when off the drugs, very few — perhaps 3 out of hundreds — contain any protocols for identifying withdrawal symptoms.

    For example, the 2006 STAR*D (Sequenced Treatment Alternatives to Relieve Depression) study, which over 7 years switched about 3,000 people from one antidepressant to another in search of the most effective treatment for depression, reported 0 (zero) cases of withdrawal syndrome — a result that defies belief. (It has long been established that one may suffer withdrawal syndrome even when taking a replacement drug.)

    (The STAR*D study’s methodology and statistical analysis have been heavily criticized. Yet, many doctors believe it is the gold standard for antidepressant treatment and to this very day are merrily switching people from one drug to another regardless of withdrawal effects.)

    All of these studies contain methods to measure “depression.” If a patient, having no other way to report withdrawal symptoms, quite logically conveys the discomfort by marking up the depression questionnaire, the data from these studies would be replete with false positive results supporting the presupposition that what happens after discontinuation is “relapse.”

    And this is so.

    (Most patients in these trials would not be aware they are experiencing withdrawal symptoms; most likely, they thought they were experiencing some new species of mental disorder.)

    That so few studies even differentiated withdrawal syndrome from relapse indicates that assumptions about antidepressant efficacy and the conclusion that people often relapse when off the drugs are incorrect. Most likely, a big chunk — maybe even most — of that “relapse” is withdrawal symptoms.

    What most likely happens after discontinuation of a psychiatric drug taken for a month or more is most likely withdrawal rather than “relapse.”

    References
    Haddad, et al., 2000, Misdiagnosis of antidepressant discontinuation symptoms.
    Deshauer, et al., 2008, Selective serotonin reuptake inhibitors for unipolar depression: a systematic review of classic long-term randomized controlled trials.
    Baldessarini, et al., 2010, Illness Risk Following Rapid Versus Gradual Discontinuation of Antidepressants.

  • On SurvivingAntidepressants.org, a peer support site for tapering and withdrawal syndrome that I’ve been running since 2011, I use quite a different model than these outdated medical philosophies.

    I myself recovered from Paxil withdrawal syndrome over 11 years. After about 5 years of research on my own, I concluded many of my symptoms were related to autonomic dysfunction. At that time, I happened to receive corroboration from a highly trained psychiatrist who had also come to that conclusion.

    Dysautonomia fit my experience like a glove, I’m pretty sure it fits most in cases. I use the model of autonomic dysfunction in counseling people on my Web site every day. It aids in interpreting the many symptoms and the many ways people describe their symptoms on my site. (Our language is not quite up to capturing these events so novel to our poor nervous systems.)

    I’ve collected and read thousands of longitudinal case studies of tapering and withdrawal syndrome. Sometimes people develop symptoms that are not dysautonomia; the stress of withdrawal may promote what may have been a subclinical condition that may never have blossomed into a full disorder, such as an autoimmune disease. And who knows what’s going on in the gut. But for the most common symptoms, it’s dysautonomia.

    (As medical diagnoses go, dysautonomia is not much of one. It’s autonomic or parasympathetic; it has many manifestations and can morph from one to another; it can arise spontaneously, wax and wane, and disappear. Nobody knows how to treat it, except regular gentle exercise and sleep generally help.)

    Understanding withdrawal symptoms as iatrogenic dysautonomia does not require either reductionist or exclusionist membership. One merely needs to be a realist. Withdrawal symptoms are unrelated to any mental illness except those DSM entries for withdrawal syndrome.

    (Joanna Moncrieff’s 2005 paper, Rethinking Models of Psychotropic Drug Action, may be of use here.)

    While we indubitably all live in a biopsychosocial model, my belief it that difficulties going off psychiatric drugs are mainly due to the biological effects of the drugs. People in all kinds of living situations, from the most supportive to the least, have similar difficulties.

    It’s undeniable that psychiatric drugs act upon the nervous system, though for some it’s mysterious exactly how this happens. To say that psychotropics change neurology is tautological.

    Therefore, while the drugs are ingested, the nervous system is affected and adapts. This includes autonomic and parasympathetic functions, with downriver effects on hormonal systems. Desirable effects are called therapeutic. Undesirable effects are called dysfunctions.

    The very common drug side effect of sexual dysfunction is evidence of autonomic and possibly hormonal alteration. (Antidepressants cause this dysfunction far more reliably than they therapeutically lift mood.)

    Similarly, through action on the body’s web of feedback loops, psychiatric drugs may derange insulin regulation and cause weight gain and even diabetes.

    The body and its systems adapt, comfortably or not, to the presence of the drugs — incurring physiological dependency. When the drug dosage changes, those systems may again be disrupted.

    Most frequently in withdrawal, autonomic symptoms, particularly a grueling sleeplessness, come to the forefront. This second wave of disruption may cause sexual dysfunction when taking the drug did not.

    From what I’ve seen, “rebound” symptoms are coincidental, not a type of symptom. Who among us, for example, has not had a spell of deep unhappiness? Or the occasional spell of anxiety? This is even more so for those who sought treatment with psychiatric drugs. However, withdrawal syndrome can cause spontaneous waves of profound existential despair or terror in people who never had an inkling of such things.

    That is an effect emanating from a dyregulated nervous system, not an emotional trigger. “Rebound” suggests these are the same old emotional symptoms, amplified. They are not, they are biochemically induced by the artificial state of withdrawal. (The content of the symptoms, however, might be the same old content, which no doubt will confuse the psychotherapists reading this.)

    I am dubious that, across the board, psychotherapy is the secret sauce for going off psychiatric drugs with minimal autonomic dysregulation. (It’s slow tapering, and even that doesn’t always work.) As so very many people are taking psychiatric drugs for no good reason, not everyone has pre-existing distress to work through, and psychotherapy has little to say about withdrawal symptoms, except to coach people how to ride them out — if the therapist actually understands that’s what’s going on.

    On the other hand, who among us wouldn’t like a little extra understanding when going through a trying time?

  • Oddly, although the Mad in America community has sympathy for all kinds of damage from psychiatric treatment, this conversation again demonstrates that somehow there is a great deal of resistance to the idea some people continue to suffer even when they are off the drugs — despite personal testimony from the sufferers. For example, would anyone state on MIA that people who claim they damaged from ECT did not in fact suffer such damage? Why are those who claim to have post-withdrawal syndrome subjected to suggestions they are perhaps deluded, mistaken, stupid, or merely experiencing some kind of relapse? In a community of psychiatric survivors, why are not those with post-withdrawal syndrome afforded the same respect and compassion as other psychiatric survivors? Why are they subjected to attacks on their personal credibility? If you didn’t like the way your doctor dismissed your understanding of yourself and your problems with psychiatric treatment, why are you doing that to other people? When it comes to post-withdrawal syndrome and the testimony of people who are suffering from it, where is the sympathy and compassion and RESPECT for fellow psychiatric survivors? Although unwitting (except for one person), the hypocrisy and meanness here hurts all the same. And it speaks poorly for the MIA community.

  • John, if you don’t believe what people who are suffering from post-withdrawal syndrome tell you about their condition, who are you going to believe?

    Why don’t you dismiss us the way psychiatrists dismiss all their patients’ complaints about adverse drug effects? We’re very used to that.

    Anyone who has realized he or she is suffering from post-withdrawal syndrome comes to that despite condemnation from their doctors, their families, their spouses, and callously uninformed comments on the Internet.

    Here’s the link to case histories http://tinyurl.com/3o4k3j5 and it is working.

  • In response to Richard D. Lewis, JOHN T SHEA, mjk, researcher, Danny S —

    Dr. Shipko is indeed correct in that some people, perhaps the very end of the bell curve, will have difficulty recovering from antidepressant withdrawal for a very long time. (I am one of them.)

    Often these people have prior history of going on and off psychiatric drugs or being switched from drug to drug without cross-tapering.

    It appears the nervous system is not made of rubber. With repeated jolts, it can be made exceptionally vulnerable to chemical and other stresses.

    As Dr. Shipko observes, under these circumstances, application of other psychiatric drugs backfires. (One might speculate that this iatrogenic damage underlies so-called “treatment-resistant depression.”) An injured nervous system requires much more gentle treatment.

    From my observation, these statements by Dr. Shipko are absolutely correct:

    “…people who stop SSRIs often develop a NEW (my emphasis) onset of severe depression or anxiety months after stopping the drugs.”

    “…the problems that sometimes occur when people try to stop an SSRI antidepressant are much more severe than the medical profession acknowledges, and there is NO (my emphasis) ‘antidote’ to these problems.”

    Although the medical profession almost invariably mistakes any withdrawal symptoms as relapse, those tardive post-withdrawal symptom patterns (even “tardive dysphoria”) are distinct from relapse or any mental condition found in nature. They are not merely “depression” or “anxiety.”

    It’s quite common that people who have no personal experience with withdrawal syndrome cannot imagine its sometimes bizarre neurological manifestations. I can assure you, it feels nothing like a normal state of mental distress.

    You may read many case histories here http://bit.ly/jAjLKr

    Dr. Shipko brings up very valid points about the dangers of psychiatric drug withdrawal, which should be factored in to the risk-benefit assessment prior to prescription of any of these drugs but, because of pharma efforts to obscure them, are not.

    Although he’s authored a paper on it, he hasn’t even mentioned Post-SSRI Sexual Dysfunction (PSSD), another post-withdrawal condition where the sufferer does not regain sexual sensation or functioning for a very long time, perhaps indefinitely, after stopping the drug.

    Like withdrawal syndrome and post-withdrawal dysautonomia, PSSD should be recognized as a risk of psychiatric drugs and incorporated into informed consent PRIOR to prescription.

    But that would require medicine to recognize these risks. I hope Dr. Shipko continues to direct his message towards doctors.

  • Thank you very much, Dr. Shipko.

    Cast as your findings regarding withdrawal, your article deserves a wider audience, perhaps on the Huffington Post or KevinMD, where it might be read by health professionals.

    They are the ones who need greater knowledge of the risks of psychiatric drugs. They need to prescribe them much less often.

    As I said up above, by the time patients get your informed consent, they’ve already been exposed to what perhaps might be unacceptable risks.

  • Dr. Shipko, I’m very disappointed by your approach to this problem.

    First, you are offering “informed consent” for people who wish to go off antidepressants. According to your theory, by then, it’s too late for them. This doesn’t help those millions of patients who are caught in the trap at all.

    You should be putting your efforts into educating doctors of your findings about the perils of withdrawal.

    Second, you dismiss the importance of tapering to protect the nervous system. Clearly, many people can taper off antidepressants and do well afterward, as many, many anecdotes on the Web reveal. We also see people recover from those tardive symptoms to which you refer. It does take time.

    As you are an expert in benzo tapering, I am confused as to why you would not apply the same reasoning to antidepressant tapering.

    Third, you dismiss the efforts of “citizen scientists” and self-help Web sites supporting tapering, which exist only because of the vacuum of knowledge among doctors.

    If these self-help resources did not exist, people who wish to go off the drugs would have no help in tapering, as few doctors even grasp the concept.

    Whether you call the symptoms “prolonged withdrawal syndrome” (symptoms being continuous from discontinuation of the drug) or post-withdrawal syndrome or whatever you want to call it, medicine pays little attention to any long-term effects of psychiatric drugs. “Citizen scientists” do. Nit-picking about nomenclature makes no sense. We both know what we’re talking about. The rest of medicine couldn’t care less.

    Fourth, the impact of your article is:

    – Don’t go on the drugs.
    – Don’t go off the drugs.
    – If you run into a problem, don’t call me.

    Is this really what you want to say?

    With your background in neurology as well as psychiatry, you could help people who have experienced long-term post-withdrawal symptoms by focusing on ways to stabilize the autonomic nervous system.

    (Tardive dyskinesia may not be the only analogy; see parallels to dyautonomia underlying chronic fatigue syndrome and fibromyalgia explored on the Beyond Meds blog http://beyondmeds.com/2013/07/24/ans-and-interaction/ There’s also traumatic brain injury, which takes a cycle of about 7 years for recovery.)

    This is why your experiments with serotonin boosters such as SAM-e and tryptophan went nowhere — you simply tried to replace the antidepressant. How would this stabilize dysautonomia? The problem is downstream of the (most likely desensitized) serotonin receptors.

    Just addressing the sleep issues alone would be of tremendous help to those suffering from withdrawal syndromes.

    I have a great deal of respect for your concern about withdrawal problems and for what you may have observed in your practice. I fear your frustration and anger on behalf of injured patients has caused you to give up on treatment of post-withdrawal symptoms. There is a crying need for someone of your caliber to delve further into this. I beg you to persevere.

  • Re June 27, 2013 at 9:17 pm comment:

    Therefore, anyone who goes cold turkey and is injured, or anyone who tapers too fast and is injured, has only himself or herself to blame.

    The psychiatric survivor community — and certainly the medical community — offers no support or comfort to these people. They are on their own.

    You go off too fast, you get injured, it’s your own tough luck.

    See http://tinyurl.com/3o4k3j5 for what these injuries, which can take many months or years for recovery, are like.

  • True, many people can haphazardly go off their drugs and not suffer unduly.

    However, others try this — skipping doses is a particularly risky way to go off — and hurt themselves terribly, with recovery taking months or years.

    Given that no one can predict how any individual might react to a dosage reduction — previous withdrawals are NOT predictive — what is the safest, most compassionate advice for someone who wants to go off psychiatric drugs?

    My position is that a conservative, gradual approach across the board minimizes risk for all, including the more sensitive nervous systems.

    The stakes are so high, it’s worth being cautious.

    Certainly, if withdrawal symptoms appear, updosing slightly is a good strategy. However, a reckless taper should NEVER be tried assuming this will be a fix — because sometimes updosing doesn’t work, the nervous system dysregulation is too great.

    I really, really wish the psychiatric survivor community would take this issue seriously. People who have quit their drugs with little difficulty tend to dismiss or even deny the grievous injury suffered by others. Bad advice to do it whatever way you want keeps going around and around.

    Think of this as protecting our community. Not every act of unprotected sex with strangers results in HIV infection, but what responsible AIDS activist would suggest using a condom only if you feel like it?

    Friends urge friends to reduce risk by being careful. Please help me spread the gospel of gradual tapering.

  • Good suggestions, Jill. Personally, I believe low omega-3 status, due to nutrient depletion in factory farming. may be a large contributor to whatever distress drives people to consider treatment with psychiatric drugs in the first place.

    However, please keep in mind that the greatest danger in withdrawing people from psychiatric drugs is not relapse of depression or whatever, which may be effectively treated with non-drug interventions, but destabilization of the nervous system and consequent hypersensitivities, about which medicine knows absolutely nothing.

    Too-fast withdrawal resulting in nervous system destabilization is like Humpty-Dumpty falling off the wall. People suffering this mostly have to let time do the healing — and it can take a lot of time.

    Omega-3 (and magnesium) supplementation seems to give many people some relief of withdrawal symptoms. We may surmise the nervous system may have been weakened by dietary deficiencies, but nervous system destabilization surpasses such remedies.

    I appreciate your interest in this issue, but to correctly conceptualize the problem, please do not confound relapse with withdrawal syndrome. They are entirely different.

  • Various official and semi-official guides to tapering psychiatric medication are listed here:

    http://survivingantidepressants.org/index.php?/topic/2930-guides-to-tapering-off-psychiatric-medications/

    Note that patient advocates, along with Peter Breggin, are advocating much slower tapers than the medical sources. We see that decreases of 25% can be much too severe for some people and generally recommend decreases of 10%.

    After all, it’s the peer counselors who are bearing this burden, which should be the responsibility of physicians, and listening to patients’ experiences.

    Please also note that withdrawal symptoms do NOT always immediately appear after dose reduction. Sometimes it takes several weeks. Therefore, 10% decreases at intervals of about a month would be safest, allowing time to catch withdrawal symptoms before attempting another decrease, which would make the withdrawal symptoms worse.

    Decreases are calculated on the last dosage, meaning the absolute amount of decrements gets smaller and smaller, maintaining a constant 10% relationship to the last dose. This creates a smooth but asymptotic curve never reaching zero.

    When to quit altogether is based on the withdrawal history. Do not quit unless you have a solid track record of no withdrawal symptoms after a decrease. For most drugs, the jumping-off point will be a fraction of a milligram.

    Fractional dosage is facilitated by utilizing liquid formulations, compounded liquids, homemade liquids, counting out beads (Effexor XR, Cymbalta), weighing powders on electronic jeweler’s scales, etc.

    Pristiq is a special case in tapering — there is no way to reliably titrate it — and should never be prescribed solely on this basis. It is generating plenty of withdrawal injuries, right up there with Effexor XR, Paxil, and Cymbalta.

  • Just wanted to point out that folks are again mistaking underlying mental distress, which can re-emerge after drug discontinuation, for withdrawal syndrome.

    Withdrawal syndrome is an iatrogenic (treatment-caused) condition. To my knowledge — and I would enthusiastically embrace any effective treatment of withdrawal syndrome — there are no alternative or natural programs that can take the place of individualized tapering schedules to reduce withdrawal symptoms.

    Please think of withdrawal syndrome as iatrogenic neurological dysregulation rather than a psychiatric disorder.

    On the other hand, many non-drug, alternative, dietary, etc. treatments can be effective to treat mental distress.

    Confusing underlying mental distress with withdrawal syndrome gets these discussions off-track. Doctors need to make going off drugs much safer in terms of minimizing withdrawal symptoms. Society also needs to provide alternatives to treat mental distress.

    People who have not seen or experienced withdrawal syndrome tend to overlook this distinction, which is extremely important. Some people can even cold-turkey off psychiatric drugs (NOT RECOMMENDED) with no symptoms. This is not true for those who are more sensitive to dosage reductions. (You don’t know if this applies to you until you hurt yourself by going off too fast.)

    Withdrawal syndrome is real, it creates additional avoidable injuries in psychiatric treatment, and deserves to be recognized in the psychiatric survivor community rather than meeting a wall of denial.

  • I am merely a peer expert and someone who is still suffering from a too-fast 3-week taper of Paxil in 2004, but I have poured my knowledge into a hundreds of pages for Web site entirely about tapering off psychiatric drugs, SurvivingAntidepressants.org

    Case histories: http://tinyurl.com/3o4k3j5

    Tapering techniques for specific drugs: http://tinyurl.com/42ewlrl

    Discussion of withdrawal symptoms and self-help: http://tinyurl.com/3hq949z

    Scientific papers: http://tinyurl.com/aqg3bjo

    To my knowledge, tapering at a rate tailored to the individual’s nervous system is the only way to minimize withdrawal symptoms. Withdrawal symptoms should be minimal. “Brain zaps,” disorientation, jolts of anxiety, and sleeplessness are not trivial and indicate the taper is too fast.

    Once the nervous system is destabilized by withdrawal, the only remedy is time, as frequently the person has become hypersensitive to all neuroactive drugs, supplements, and even foods. Very, very gentle interventions might make withdrawal symptoms more bearable. Most people do well with fish oil and magnesium, which tend to reduce anxiety and probably reflects a pervasive dietary deficiency in these important nutrients.

    It is a widespread medical falsehood that withdrawal syndrome is invariably mild, self-limiting, and lasts only a few weeks. If you look closely at the sources for this information, you will find pharma sponsorship.

    Medicine’s refusal to take this issue seriously has grievously injured many people. There are hundreds of thousands of reports all over the Web of severe withdrawal syndrome lasting many months or years.

    There are untold millions who are stuck on their drugs because they suffer withdrawal every time they reduce the dosage and their doctors do not know how to taper them properly.

    This is truly an epidemic.

    PS Dr. Joseph Glenmullen’s “The Antidepressant Solution” is probably the best text for doctors to learn proper tapering techniques and how to monitor for withdrawal symptoms. It was published in 2006. Isn’t it time for doctors to read it?

  • First of all, no self-respecting AIDS activist would say “you decide” when it comes to unprotected sex, except sarcastically.

    With HIV/AIDS, an intensive world-wide health education campaign has done a pretty good job of telling people what will happen if “you decide” leads them to unprotected sex.

    After many years of horror stories, they have been scared out of their pants and into condoms.

    This was not facilitated by AIDS activists being wishy-washy with “sparse or contradictory” information — even when information was sparse and contradictory — or offering a libertarian “you decide,” but AIDS activists uniting and giving an unambiguous message: “It’s dangerous, don’t do it.”

    Can you tell me how the general public is being educated about the dangers of cold turkey or too-fast discontinuation of psychiatric medications? Has the worst-case scenario been made explicit? Most doctors will deny it.

    If you think people know what’s in store for them with severe withdrawal syndrome, read 10 of these stories http://tinyurl.com/3o4k3j5

  • I don’t know what Will Hall is saying in his public speaking these days. His post on MIA (linked in my comment above), uncharacteristically muddled, showed a great deal of ambivalence about cold turkey.

    Yes, I do believe people who are speaking and writing for audiences who might be considering going off their psychiatric medications should be UNEQUIVOCAL about cold turkey.

    I’ve given many examples of how to consider the risk. As I pointed out in HIV transmission, for any one unprotected sexual encounter, the risk is approximately 1 in 200. And yet what gay activist would be suggesting if people feel like having unprotected sex, they should go ahead and do it?

    (By the way, in the early days of AIDS, there was quite a bit of resistance to the idea that one should always use protection, with the same kinds of rationalizations. In the general population, there still is.)

    We are all horrified by the prescribing of psychiatric medications to pregnant women, yet in truth, the absolute risks to the developing baby are much, much smaller than the risk of damage after cold turkey.

    For example, the risk of an autism spectrum disorder after valproate treatment is put at 4.42 percent according to a recent study http://www.medicalnewstoday.com/articles/259597.php

    Translated to psychiatric medications, this means Laura might meet 96 people who got away with cold turkey before she meets 4 who didn’t (if they were able to get out, that is).

    What this conversation demonstrates is the inability of even intelligent people to grasp the idea of medical risk. It’s not a majority vote.

    Laura and others should take this as a caution against making assumptions that their audiences 1) will do any research in the risk of cold turkey; 2) be able to assess such information about risk if they do find it; and 3) make logical decisions about going off psychiatric drugs.

    I regret very much pounding on Will and Laura about this, but I believe the stakes are very high. People need to be reminded about how dangerous it can be to go off psychiatric drugs suddenly — they’re inclined to do it anyway. They don’t need additional approval or permission for a risky action.

  • My position is that people like Laura and Will Hall, who are sometimes in a position to influence large numbers of people in their speaking and writing, should not encourage cold turkey, implicitly or explicitly, because cold turkey is dangerous and creates lasting injuries.

    I’d rather people be cautious in going off drugs so they DON’T end up on my Web site.

    The warnings about cold turkey are already quite stern. This is what they amount to: DON’T DO IT.

    This is one warning from the medical establishment that everyone on MIA should be supporting and yet it’s an uphill battle. Why?

  • Laura, this is the fourth or fifth or sixth time I’ve heard or read your phrase “There is simply no one right way to come off psychiatric drugs.”

    Each time my reaction is the same: You have carefully formulated this phrase not to exclude cold turkey as a way to come off psychiatric drugs. (As I have discussed with you.)

    What would it cost you to change this to “Tapering is the safest way to go off psychiatric drugs. Don’t cold turkey if you can possibly help it.”? Why do you deliberately and repeatedly give tacit approval to cold turkey? Is there a cold turkey lobby?

    According to the HIV analogy, here’s your logic:
    – There’s no one right way to have sex with strangers.
    – Some people don’t get HIV when they have unprotected sex with strangers.
    – Having unprotected sex with strangers might be perfectly fine, if that’s what you prefer.

    What’s missing: Some people do get HIV from unprotected sex with strangers, and HIV is such a serious condition that you will take precautions against contracting it.

    (For what it’s worth, Will Hall ran aground on the same argument here https://www.madinamerica.com/2012/11/medication-withdrawal-or-medicationtapering-a-harm-reduction-approach/ )

    Seriously, who wouldn’t prefer having carefree, unprotected sex with strangers? Who wouldn’t prefer cold turkey off psychiatric drugs compared to the work of tapering?

    People hardly need permission to cold turkey. They do it all the time. Nothing stops them — they don’t bother to educate themselves (until it’s too late). They hear stories of successful cold turkeys and they think great, I’ll do that too.

    Maybe they secretly think if they get hurt, some nice doctor will give them a pill that will fix them right up.

    Then, ouch, it doesn’t go so well. But unlike HIV, there is no medical support for withdrawal syndrome and darn little other support. Even in a community such as MIA, a person with withdrawal syndrome will be a pariah, because everyone here wants to believe you can simply go off psychiatric drugs if you want to change your life. Withdrawal syndrome is a reminder that it’s not so simple.

    As long as you use “There is simply no one right way to come off psychiatric drugs,” in your speaking and writing, giving tacit approval to cold turkey, we will be working at cross-purposes.

    By the way, what I said above was “If you can manage it, there is only one way — that is to taper at a rate your nervous system can tolerate.” By definition, cold turkey is not a tapering method, any more than black is white.

  • Yes, there are anecdotal reports of successful cold turkey, and there are anecdotal reports of disastrous cold turkey. No individual knows what will happen in advance should he or she take the irrevocable step of quitting suddenly.

    Although medicine has been indolent about adverse effects of psychiatric drugs in general and pretty much covered up the potential severity of withdrawal syndrome, its injunction against cold turkey has been consistent and universal. Why?

    In the beginning, cold turkey was the way everyone was taken off SSRIs, which were assumed to have no withdrawal issues. When the results of cold turkey surfaced — that would be in the Prozac era — they were so horrific that researchers united in warning against cold turkey. (Another myth: Prozac is “self-tapering.”)

    If you read the journal literature about withdrawal syndrome, such as that authored by Peter Haddad, you will see that researchers allude to severe “morbidity” from too-fast discontinuation. However, those cases are unpublished. The evidence has been buried, all that remains is the warning.

    Not that what psychiatry researchers think has any weight in this crowd; I’m pointing this out because even psychiatry researchers who would much rather ignore the problem felt compelled to warn against cold turkey, it was that serious.

    Now let’s look at the validity of anecdotal information. That is all we have, because medicine got bored with psychiatric drug withdrawal syndromes in the mid-2000s. Unless someone does an epidemiological study, it’s unlikely any hard statistics will ever be produced about the danger of cold turkey.

    So you know people who did well, and we all know people who did not. You’ve taken 3 years to recover, I’m in my 8th year of recovery (it’s taken a very bad turn lately). You can look forward to a new life, I’m older and my life has been destroyed.

    No one who hasn’t experienced severe withdrawal syndrome understands how painful and debilitating it is. A positive attitude can’t erase the minute-by-minute torture. It comes down to a will to live. Few people can grasp the prospect of suffering with no options.

    If you say any which way of coming off might suit, you must also take on the moral burden of explaining what happens when the bet goes bad. Otherwise, you present the benefit without the risk.

    (Also, if any way of going off might suit, why even bother collating a directory of practitioners who support tapering? Anyone can improvise their own way of going off and take their chances.)

    This discussion, which has played out several times on MadinAmerica, makes me discouraged and angry. I run a Web site that is one of the few offering support for people with prolonged withdrawal syndrome. Other sites exclude them. Their situation, which I share, is tragic.

    Laura, your formulation “there is no one right way to come off of psychiatric drugs,” which you use in your speaking and writing, unintentionally drives business to my site that, frankly, I don’t want to have.

    It is no mystery that most people do okay with going off psychiatric drugs. There’s the famous “2 weeks of mild symptoms” — right up there with “the check’s in the mail” as one of the great lies — that most people quitting SSRIs are supposed to experience.

    But some hurt themselves very, very badly by going off too quickly. Perhaps Russian roulette is too romantic a metaphor. A better one might be having sex with strangers. Not every incident results in HIV infection; the risk is estimated at about 1 in 200 encounters.

    That’s right — that’s what a huge worldwide public education campaign has been about, a campaign that’s changed the sexual behavior of millions of people, some of whom were quite resistant to that change.

    Why, if the risk is only 1 in 200, are people urged to always use condoms? It’s because the outcome of a bad bet is so drastic. Taking precautions is important not because of frequency of infection but magnitude of damage.

    I have absolutely no doubt that severe withdrawal following cold turkey occurs much more frequently than 1 in 200. Of the pregnant women I mentioned above, 30% reported “unbearable” symptoms and 12% ended up in the hospital. (What do you think happened to them there? If they were really, really lucky, their antidepressants were reinstated. Back to square one.)

    That’s why encouraging people to taper to prevent withdrawal syndrome is so important. You only have one nervous system, and it’s not made of rubber.

    And that is why I take exception, yet again, to your “each to his or her own” position. You are hiding the risk of withdrawal syndrome to make a rhetorical point: One can be free of psychiatric drugs. I agree with you on that, but I wish you would encourage people to taper rather than include cold turkey as just one of those preference things.

  • Beautiful writing, thank you, Laura.

    As you know, when I likened cold turkey to Russian roulette, what I was saying was you could hurt yourself very badly by taking that risk.

    Yes, it’s true some people play Russian roulette and win the bet. But others do not.

    The successful cold turkey-ers testify about how they got away with it, and good for them. The ones who failed are wandering the Internet — or going from doctor to doctor — begging for a cure.

    If you’re unlucky and shoot yourself in the head, you could end up with problems much worse than being poly-drugged.

    There is no cure but time for severe withdrawal syndrome.

    Every single failed cold turkey who’s come to me for advice and support had every intention of winning the game. Each and every one thought he or she would have, at most, a few weeks of feeling lousy and then be finally free.

    For a glimpse of the odds of successful cold turkey, see this study:

    J Psychiatry Neurosci 2001;26(1):44–8.
    [b]Abrupt discontinuation of psychotropic drugs during pregnancy: fear of teratogenic risk and impact of counseling. [/b]
    Einarson A, Selby P, Koren G.

    Abstract at http://www.ncbi.nlm.nih.gov/pubmed/11212593 with free full text.

    Experiments in cold turkey are considered unethical because cold turkey is so thoroughly regarded as harmful. Therefore, observations need to be based on accidental cold turkey.

    In the study, out of 34 women who quit abruptly
    • 26 (70%) reported physical and psychological adverse effects
    • 11 (30%) reported suicidal ideation “because of ‘unbearable’ symptoms,” and 4 were hospitalized

    An additional 3 women “used some form of tapering off. This tapering was unsatisfactory, however, because even these patient suffered from adverse effects.”

    “One woman had a therapeutic abortion because she did not feel she could go through the pregnancy feeling so awful….”, another considered it.

    Correct — severe withdrawal syndrome caused 2 of 34 pregnant women, who had quit antidepressants to protect the babies they were carrying — to consider terminating their pregnancies.

    As before, I respectfully and strongly disagree with your position that there is no one way to come off psychiatric medications. If you can manage it, there is only one way — that is to taper at a rate your nervous system can tolerate.

    If you are a person who happened to have been successful at cold turkey, you were lucky. Unless you have developed an ability to predict the future, please do not urge others to take this risk.

    (If you still insist cold turkey is a “right,” I invite you to join my site, SurvivingAntidepressants.org, and provide emotional support for the people who are suffering from cold turkey gone wrong.)

    I am sorry to take this politically uncorrect position yet again on MadinAmerica.com. I am sorry that the prison of psychiatric treatment isn’t easier to escape. These drugs are pernicious from start to finish. It’s hard to get free. That’s just the way it is, and it does no good to anyone to pretend the reality is otherwise.

  • Very, very few studies on relapse after discontinuation (or, in this case, relapse after inconsistent dosing) include protocols to distinguish withdrawal symptoms from relapse.

    (In fact, out of dozens of relapse studies, I’ve seen only one that recognized withdrawal symptoms.)

    Therefore, all such studies are confounded by withdrawal symptoms mistaken for relapse.

    The expectation of relapse after drug discontinuation permeates the entire practice of psychiatry, and may be false, or at least overblown, by this confounding.

    Given the very great difficulty psychiatrists have in recognizing any kind of adverse effects, often blaming them on the person’s psychiatric disorder, I suggest any statistics of relapse in these situations be taken with a large dose of salt.

    As for rebound psychosis — as I’ve suggested in comments elsewhere, a nervous system destabilized by withdrawal expresses itself in a wide range of symptoms. Even people who never had any hint of psychosis pre-drug, as in people taking antidepressants or benzos, can have “psychotic” symptoms in withdrawal.

    If the person is otherwise asymptomatic on medication, and “psychotic” symptoms appear after withdrawal, I suggest this is not evidence that the drug is needed to control such symptoms but that tapering was too fast, precipitating nervous system destabilization. The withdrawal symptoms may match earlier “psychotic” symptoms because of the particular sensitivities of that person’s nervous system.

  • Another excellent article, thank you, Sandy.

    Once someone has been on any of these drugs for longer than a few weeks, withdrawal symptoms should be suspected whenever doses are skipped.

    Could you tell me what protocols in those studies were in place to distinguish “relapse” from withdrawal symptoms?

    From what I’ve seen, any type of distress is called relapse, and withdrawal symptoms can cause a lot of distress.

  • Dr. OBrien, I see your posts on the most recent Pies article http://www.psychiatrictimes.com/blog/pies/content/article/10168/2138321 . In this article, Pies asserts what he always asserts: If psychiatry is done properly, it accomplishes “the relief of suffering and incapacity.”

    This tautology, which is vintage Pies, is as circular as an argument can get. And yet he says “the medicalization narrative is philosophically naive and clinically unhelpful.”

    I also see your comments on http://www.psychiatrictimes.com/blog/pies/content/article/10168/2135248 . Here Pies touts (yet again) psychiatry as a scientific “systematic methodology based on evidence,” ignoring (yet again) the extensive, indisputable findings that much of psychiatric “evidence” is pharma propaganda.

    As for stigma, he maintains that psychiatric diagnoses are merely innocent words, it’s society that supplies the stigma, thereby making the terms context-free. (As though no physician ever applied a psychiatric diagnosis out of prejudice or ignorance!!)

    This type of semantic reductionism is also vintage Pies. Words, e.g. DSM-5 diagnoses, are innocent! Stigma is in the interpretation!

    Could someone please let Dr. Pies know words have no meaning without interpretation?

    You may enjoy jousting with Dr. Pies, but be forewarned — his articles are a compendium of rhetological fallacies ( http://www.informationisbeautiful.net/visualizations/rhetological-fallacies/ ), as you would expect from someone suffering from anosognosia regarding the profession he’s spent a lifetime defending (as Dr. Nardo’s March 30 comment implies).

  • And, please, let us not forget the relationship, found in studies, between post-partum depression and the new mother feeling socially isolated and not having assistance at home with the infant.

    This is another symptom of nuclear families living apart from the extended family, long-time community ties, and traditional support systems. No wonder new mothers feel overwhelmed.

    What prospective mothers might very well need is friends like them. They should be guided into peer support networks as part of their prenatal care.

  • I disagree with Mr. Pies that psychiatry is not responsible for the status quo. Where are the American Psychiatric Association initiatives on gathering post-marketing data on psychiatric drugs, for example?

    Here are some more slices of Pies:

    Critics of psychiatry are people who just want others to suffer:
    http://psychcentral.com/blog/archives/2011/09/13/are-the-puritans-behind-the-war-on-antidepressants/

    Here he embarrasses himself with the non-credible claim that psychiatrists never espoused the “chemical imbalance” theory:
    http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1902106 (free registration required)

    Trying to dig himself out of the hole he’d dug in the earlier article, he says psychiatrists lied about “chemical imbalance” only to make patients feel better:
    http://psychcentral.com/blog/archives/2011/08/04/doctor-is-my-mood-disorder-due-to-a-chemical-imbalance/

    And, for the whipped cream on Pies, his colleague Steve Moffic, “da man in psychiatric ethics,” on the importance of informed consent:
    http://www.behavioral.net/blogs/h-steven-moffic/preventing-epidemic-psychopharmacology-lawsuits

  • Fish oil might be a fad, but it can do something good for some people. When I was suffering the worst of antidepressant withdrawal syndrome and was at the height of hypersensitivity, after I took my fish oil capsules, I could feel its soothing effect.

    I’ve been taking 2,000-4,000mg DHA and EPA daily for many years. My good cholesterol is so high, I’ve been exempted from being harassed to take statins for cholesterol control.

    I would not be without my fish oil. I’d love to get my omega-3s from food, particularly fish. If they weren’t a mercury hazard and mostly endangered, I’d eat them every day. Unfortunately, it would have to be as sushi — because cooking destroys the omega-3 fatty acids, as you would expect.

    As it is, I eat sushi every chance I can get. I wish I could afford more of it.

  • No wonder. The author is a psychoanalyst.

    “Dr Blum is a psychiatrist and psychoanalyst in private practice in Philadelphia. He is on the faculty of the Psychoanalytic Center of Philadelphia and is Clinical Assistant Professor of Psychiatry at the University of Pennsylvania.”

  • Even addiction specialists are confused about the distinction between physical dependence and psychological dependence on drugs.

    According to the semantic medico-legal distinction between addictive and non-addictive, which sometimes doesn’t make any sense, being addicted to a drug means you have both physical dependency and psychological dependency.

    When it comes to benzos, this distinction is particularly unclear. Benzos can be truly addictive. People can become dependent on benzos in either purely physical or physical-psychological ways. They can be innocently taking exactly the prescribed dosages and get physically dependent, or they can be going for more and more of the psychic numbing and become textbook addicted.

    Textbook addicted or not, it is the physical dependency that causes withdrawal symptoms.

    Doctors and addiction medicine specialists have difficulty distinguishing between the two. All they know is benzos are addictive, if you have trouble going off them, you must be an addict. They think dependency of any type is addiction.

    From what I’ve seen, one distinction between people who meet the definition of addicts and those who are victims of medical ignorance about psychiatric drugs causing dependency is that, once they get off the drugs, the non-addicts never want to go anywhere near them again, and quite often develop an aversion to the entire medical profession as well.

  • As I commented on Dr. Kelly Brogan’s post regarding medicating pregnant women https://www.madinamerica.com/2013/03/to-medicate-or-not-to-medicate-that-is-not-the-question/ :

    Neonatal withdrawal syndrome is well documented. Like adult withdrawal syndrome, it is assumed to last only a few weeks. In neonates, this is when the baby stops continually crying and spasming.

    However, in adults, withdrawal syndrome may last quite a bit longer than a few weeks, sometimes into a lengthy post-acute withdrawal syndrome (PAWS) phase, as with other drugs of dependency — see https://www.madinamerica.com/2013/03/alarming-report-on-antidepressant-side-effects/ .

    The authors of the above-referenced paper, based on anecdotal patient reports, refer to a “postwithdrawal phase, consisting of tardive receptor supersensitivity disorders.”

    We really don’t know what’s going on with neonatal withdrawal syndrome. The baby might stop crying and twitching, but may be suffering the newborn version of depersonalization (for example) for months or years, as adults do.

    Let us hope that neonatal neuroplasticity compensates and accelerates recovery from the supersensitivity disorders, and does not devolve into, say, autism.

    Allow me to add: Hypersensitivity to various stimuli and neuroactive drugs, supplements, and even foods is a very, very common withdrawal symptom when adults go off antidepressants too precipitously. Who knows what these tiny babies are experiencing?

  • Health industry group: Replace psychiatrists with vending machines
    Measure to reduce health care costs

    1 April 2013 Health Insurance Times (Dubuque, Iowa) A health care industry thinktank, US Health Insurance Consortium on Cost, advocates replacing psychiatrists and other doctors with vending machines to prescribe and dispense antidepressants.

    “We believe this will cut the cost of psychiatric services significantly,” Uli Arnowsky, spokesperson for USHICost, said. “Our studies show the diagnosis and prescription process can be automated, with no loss in quality of care. Specialist costs are just not necessary for this type of treatment, and psychiatrists are overworked anyway.”

    USHICost’s plan is to make the Psychiatric Diagnostic Screening Questionnaire (PDSQ), based on the new diagnostic manual DSM-5, available online to health plan members. Answers would be captured in a database and analyzed to produce a recommendation for a prescription. A psychiatric nurse reviews the recommendations and authorizes the prescription, which is then attached to the patient’s database record.

    Vending machines, in convenient medical center locations and on a secure network, would be stocked with the most common generic antidepressants.

    “We prefer the generics,” Arnowsky said. “They’re part of the cost-cutting. Our studies show they’re just as effective as the name-brand drugs.”

    According to Arnowsky, to get a prescription filled, a patient would input a health plan ID and a password at a vending machine. The machine would look in the database, dispense the authorized prescription, and charge the copay to a credit card on file in the patient’s health plan record.

    “We really like the way this system keeps electronic medical records, too,” Aronowsky said. “It’s a win-win-win for all concerned.”

    Patients reporting side effects would be advised to see their doctors, who could then adjust the prescription if needed.

    “There’s a lot of trial and error in prescribing antidepressants already,” he said. “This system is no more error-prone than present prescribing practices. In fact, we put fuzzy logic in the system to rotate prescriptions among the antidepressants, because we’ve found doctors prescribe them in an almost random fashion. We built the human element right into the system — it thinks just like a doctor about these drugs.”

    He stated that USHICost’s studies had shown diagnosis by PDSQ was at least as accurate as by doctors, including psychiatrists. “This will take a big burden off primary care physicians, too, who are bearing the brunt of prescribing antidepressants,” he noted.

  • I believe disruption of homeostasis, whatever the mechanism, is the key to how psychiatric drugs “work” (if they can be said to work). Some people interpret the disruption as beneficial, others adverse, and others don’t feel it.

    Disruption of nervous system homeostasis often has unintended consequences far from the therapy target, e.g. sexual disfunction.

    Once the entire organism accommodates to an artificial hormonal elevation, whether by psychiatric drugs or steroids, a second homeostasis is created that depends on continued application of the drug.

    As Hochberg, et al, say in Endocrine Withdrawal Syndromes http://edrv.endojournals.org/content/24/4/523.long#ref-166
    “Long-term adaptations to hormones may involve relatively persistent changes in molecular switches, including common intracellular signaling systems, from membrane receptors to transcription factors.”

    (The authors believe, erroneously, that rather than throwing another wrench into the works, antidepressants will ease the withdrawal transition. Why can’t they figure out these represent another excessive hormonal therapy?)

    Removal of the artificial hormonal elevation by drug withdrawal requires re-adaptation to yet another homeostasis tending toward normal functioning. As medicine is largely willfully ignorant of these iatrogenic effects, how long that might take — or how complete it might be — is a mystery.

    This is true in adult and neonatal psychiatric drug withdrawal syndromes. Depending on the discipline, that iatrogenic state of autonomic dysregulation is variously described as post-acute withdrawal syndrome, supersensitivity psychosis, kindling, and HPA axis dysregulation.

    What that final post-drug homeostasis might feel like probably varies among individuals. Given the influence of the drugs and the passage of time, it is unlikely that the nervous system reverts to factory settings. You can’t step in the same river twice, especially if it’s been flooded with artificial hormones.

    What this argues if, if drug intervention is required, the absolute minimum effective dosage be used to minimize disruption to the original nervous system homeostasis. The usual dosages in psychiatry are more like bludgeons to the nervous system rather than subtle corrections.

  • Just published:

    Dan Med Bull. 2011 Sep;58(9):A4303.
    Paediatric outcomes following intrauterine exposure to serotonin reuptake inhibitors: a systematic review.
    Fenger-Grøn J, Thomsen M, Andersen KS, Nielsen RG.

    Abstract and free full text at http://www.ncbi.nlm.nih.gov/pubmed/21893008

    The use of serotonine reuptake inhibitors (SRIs) is increasing among Danish pregnant women. This systematic review addresses the potential adverse effects on the foetus and child of maternal SRI medication. The literature indicates a slightly increased risk of cardiovascular malformations and persistent pulmonary hypertension of the new-born, while evidence regarding the risk of preterm labour, low birth weight, low Apgar score, prolonged QT interval and miscarriage is less clear. An estimated 20-30% of infants will have neonatal symptoms following intrauterine SRI exposure. The symptoms may be caused by SRI withdrawal, toxicity or their overlap, but symptom aetiology basically remains controversial. The infants may exhibit neurological, gastrointestinal, autonomic, endocrine or respiratory symptoms. Although the symptoms are self-limited, the families may be seriously affected. In general, studies do not address this important aspect. Evidence concerning long-term effects is surprisingly sparse and many studies have important methodological limitations. However, present evidence does not convincingly indicate detrimental long-term effects. Until sufficient safety studies have been carried out, SRI must be used with caution in pregnancy and every treatment of the pregnant woman should be thoroughly considered.

    Please allow me to say again: The assumption that neonatal withdrawal symptoms are “self-limited” is based on very limited evidence. The same assumption pertaining to adults is contradicted by hundreds of thousands of reports on the Web of withdrawal syndrome lasting many months or years.

  • I am wondering about the dopamine supersensitivity hypothesis.

    What we are seeing when people withdraw from SSRIs and SNRIs too precipitously — even when they had no withdrawal symptoms while tapering or for months afterwards — is a recognizable supersensitivity to stress, evidenced by unprecedented symptoms described as anxiety surges, panic attacks, and a harsh sleeplessness over days or weeks.

    Anxiety surges in the early morning are a common feature, an exaggeration of the diurnal cortisol peak that normally gets us ready to wake up and start our days.

    As SSRIs and SNRIs have only an indirect effect on dopamine, it’s unlikely that dopamine alone is the culprit for these tardive symptoms. Rather, they’re due to a more generalized disruption of autonomic regulatory systems resulting in over-representation of alerting activity.

    These psychiatric drug withdrawal symptoms have a lot in common with endocrine withdrawal symptoms, see

    “….Interestingly, hormones with completely different physiological effects can produce similar withdrawal syndromes, whereas some of the clinical manifestations that are due to the chronic presence of high hormone levels or withdrawal syndromes are also observed with drugs of abuse. This review postulates that changes of the hypothalamic-pituitary-adrenal (HPA) axis and the central opioid peptide, noradrenergic and dopaminergic systems act as shared features in the pathogenesis of several endocrine withdrawal syndromes…..”

    They repeatedly advise slow tapering to avoid such symptoms.

    Although the authors are struggling to associate particular symptoms with putative hormonal mechanisms, which I believe is barking up the wrong tree (the right tree being a more generalized autonomic disruption), the overlap of endocrine withdrawal symptoms with what we know of antidepressant withdrawal syndrome is striking (see Figure 2 in the paper http://edrv.endojournals.org/content/24/4/523/F2.large.jpg ).

    In terms of autonomic disruption, there may be no real distinction between playing with levels of neurohormones and playing with endocrine hormones.

    I suggest that the supersensitivity psychosis seen after even apparently uneventful withdrawal of antipsychotics is parallel to the stress hypersensitivities very frequently seen in SSRI and SNRI post-withdrawal syndromes, but expressed as “psychotic” symptoms reflecting the particular neurological variability of those who came in hearing voices, etc.

  • Sandy, I’d be interested to see what you think of the new article by Martin Harrow and Thomas Jobe https://www.madinamerica.com/2013/03/do-antipsychotics-worsen-long-term-schizophrenia-outcomes-martin-harrow-explores-the-question/

    As quoted by Bob Whitaker, Harrow and Jobe say: “The discontinuation effect includes the potential of medication-generated buildup, prior to discontinuation, of supersensitive dopamine receptors, or the buildup of excess dopamine receptors, or supersensitive psychosis….” which would suggest some “relapse” is a withdrawal effect.

  • Those elevations in inflammatory markers seen in the “treatment refractory” (if they exist) may be the result of repeated insult by serial medications.

    Has anyone considered not meddling in brain chemistry of these people for a while to see if such markers decrease?

  • How excellent that Martin Harrow revisits his own study and elaborates on his interpretation of his own findings!

    You bet, some “relapse” is withdrawal syndrome, as Harrow and Jobe say: “The discontinuation effect includes the potential of medication-generated buildup, prior to discontinuation, of supersensitive dopamine receptors, or the buildup of excess dopamine receptors, or supersensitive psychosis….”

  • Hermes, this is an endless discussion, and off-topic attached to Sandy’s blog post, but I would challenge that antidepressants have any magical effect on depression specifically.

    Rather, like amphetamines and other psychoactive substances, they are stimulating or cause other neurological noise (such as emotional anesthesia) that some people report as relieving symptoms of “depression” (whatever that is). Others report effects that they feel as adverse, including — quite commonly — overstimulation.

    Antidepressants don’t “work” for depression any more than, say, LSD “works” for depression.

  • Very good post. However, Dr. Brogan says “there still isn’t a clear signal of any reproducible, consistent teratogenicity or danger that is definitely not attributable to the underlying illness.”

    Neonatal withdrawal syndrome is well documented. Like adult withdrawal syndrome, it is assumed to last only a few weeks. In neonates, this is when the baby stops continually crying and spasming.

    However, in adults, withdrawal syndrome may last quite a bit longer than a few weeks, sometimes into a lengthy post-acute withdrawal syndrome (PAWS) phase, as with other drugs of dependency — see https://www.madinamerica.com/2013/03/alarming-report-on-antidepressant-side-effects/ .

    The authors of the above-referenced paper, based on anecdotal patient reports, refer to a “postwithdrawal phase, consisting of tardive receptor supersensitivity disorders.”

    We really don’t know what’s going on with neonatal withdrawal syndrome. The baby might stop crying and twitching, but may be suffering the newborn version of depersonalization (for example) for months or years, as adults do.

    Let us hope that neonatal neuroplasticity compensates and accelerates recovery from the supersensitivity disorders, and does not devolve into, say, autism.

    As for post-natal depression, studies show that mothers who feel isolated are more prone to this. Dr. Brogan, I urge you to add peer support groups for mothers-to-be and new mothers as an intervention to improve the health of mother and baby without resorting to treating with psychiatric drugs.

  • While I share your concern about communicating the dangers of psychiatric drugs, I wouldn’t deny reality to support an argument against them.

    Many people say they do recover completely. If we don’t accept their subjective opinion of recovery, how would we assess recovery?

    The suffering people incur along the way to recovery is enough of a demonstration that these drugs should be prescribed much, much less frequently and that medicine should know much, much more about tapering.

  • I agree that, by and large, taking a supplement is a lot less dangerous than taking a psychiatric drug. (However, I’ve got a couple of cases of people having difficulty withdrawing from SAM-e….hmmmm….)

    I get outraged about any kind of dishonesty in health treatment, alternative or allopathic.

    Some people just don’t have the money to waste on misrepresented treatments. For example, many naturopaths will order urine tests that purport to measure neurotransmitter balance from a company called NeuroScience. The lab reports come complete with recommendations for NeuroScience’s pricey supplements formulated to correct whatever neurotransmitter imbalances are found. How could this possibly be valid?

    I wish now I had the several hundred dollars I wasted on that bogus testing and those supplements when I was much more naive.

    (Many people have adverse reactions to NeuroScience supplements, which contain various neuroactive ingredients.)

    Like TrueHope’s EmpowerPlus, Immunocal is another supplement for which the manufacturer, Immunotec, generated studies and a lot of scientific-sounding blather supporting its use. Immunotec also got Immunocal approved as a prescription “medical food” reimbursable by Medicare. Immunocal is a whey protein isolate. Unlike other whey protein isolates, supplement composition for Immunocal is held secret.

    From what I can glean, Immunocal is roughly equivalent to NOW Whey Protein Isolate, which lists its composition on its label and is available without prescription. The difference: Immunocal is 15 times more expensive. You (or Medicare) pay $85.00-$99.00 for 300 grams of Immunocal; for the same amount of money, you can get 4536 grams of NOW Whey Protein Isolate.

    Beyond cost, there are real dangers in supplement manufacturer misrepresentations. Neurocritic discusses TrueHope’s liabilities in this post http://neurocritic.blogspot.co.uk/2012/07/empowered-to-kill.html , which includes some very interesting transcripts of TrueHope support calls with people desperate for solutions to their health problems.

  • When you say not hearing about this, do you mean from your patients or other physicians?

    (If physicians — no surprise there. Most could not recognize a withdrawal symptom if it jumped up and bit them.)

    If patients, how are they doing after the second 25% reduction?

    We’re seeing people often can get about half-way down before further decreases cause withdrawal symptoms. My guess is because there’s a lot of excess capacity in common dosing levels.

    Also — people with no prior history of “psychotic” symptoms who are reducing antidepressants or benzos sometimes report psychosis-like withdrawal symptoms, such as hallucinations or depersonalization.

    I suggest this is indicative of withdrawal-induced nervous system instability. A person with a history of “psychotic” symptoms whose nervous system has accommodated to a drug may become similarly destabilized upon withdrawal. More gradual tapering would maintain the stability achieved on medication.

    Sleep disturbance during tapering is an indication of destabilization.

    There are many ways to reduce dosage by amounts smaller than the tablets supplied by drug companies. People use the liquid form of the drug, split tablets, weigh fragments with digital scales, open capsules to count out beads, have drugs compounded into liquids and smaller capsules, and make their own liquids with water or the Ora-Plus suspension base. They become expert in the use of oral syringes.

  • I was referring, probably too obliquely, to the Deplin studies.

    Still, that there is a population with folate processing difficulties — or subclinical low B12 — who might display “psychiatric” symptoms suggests we should do a much better job of screening for those conditions before treating with psychiatric drugs, which do absolutely nothing for the vitamin deficiencies.

  • Sandy, in my opinion, a dosage reduction of 25% is going to be too much for some of your people. If you observe them for a month, the most sensitive will become apparent — and they will be suffering a lot.

    However, for a middle group, withdrawal symptoms sometimes don’t show up for months. If by the second month you’ve decreased by another 25% or 50%, you’re putting those people in jeopardy of withdrawal symptoms after the final dose.

    To minimize withdrawal symptoms, I suggest a reduction of 10% the first month and another 10% for a second month. With 2 months’ observation, you will be able to tell who can reduce faster, by 10% every 2-3 weeks, and most of those who need to reduce slower.

    If this seems like a pain in the *ss, well, yeah, it is. That’s what the physical dependency incurred by these drugs does — puts those who are more neurologically vulnerable at risk for withdrawal symptoms.

  • Doesn’t it seem odd to you that people who have low B12 and folic acid are being diagnosed with psychiatric disorders and treated with psychiatric drugs instead of B12 and folate?

    That’s what those studies are finding — a fairly significant rate of misdiagnosis of relatively simple B12 and folate deficiencies.

    Psychiatry should be apologizing to those people instead of recommending “adjunct” treatment with B12 and folate!!!

    Bonnie Kaplan has, unfortunately, sullied her reputation by her association with the TrueHope company and their supplement EmpowerPlus, which is nothing but an overpriced ordinary multivitamin for which its manufacturer makes excessive claims.

    (TrueHope’s activities are of great concern to me because it also gives out bad information about tapering off psychiatric drugs — with the help of its supplements, of course.

    This is not to say that nutrients and the lack thereof cannot be involved in producing “psychiatric” symptoms and supplementation may relieve those symptoms.)

    In 2006, I wrote to Bonnie Kaplan, whose research is what TrueHope uses to back up its claims. Here is her response:

    Date: Thu, 16 Feb 2006 12:16:24 -0700
    From: “Bonnie Kaplan”
    Subject: [altostrata]
    To: [altostrata]
    Hello [altostrata],
    I’m glad you are checking on ingredients, because the supplement has
    changed since the list in the 2001 publication. The company was able to
    change the processing to provide a much finer particle size for the
    minerals, which seems to enhance the absorption of the minerals (makes
    sense), and so the quantities of some were reduced by a third. The
    current adult full dose = 15 capsules/day (not 32, as it was in 2001).

    You asked about two ingredients in particular. I believe the current
    level of inositol is just 180 mg (very tiny compared to the literature
    on inositol using it in isolation), and the phenylalanine is 360 mg. You
    could check with the company on their website (truehope.com), or phone
    them.

    I’m not affiliated with the company, and in fact I will paste below a
    prepared message that I use when responding to email queries. There may
    be other information in it that is relevant to you.

    Best of luck to you,
    Bonnie Kaplan

    ————————————————-
    Thank you for inquiring about the University of Calgary research on
    micronutrient supplementation in the treatment of bipolar disorder. The
    supplement we are currently studying is available commercially as
    Empowerplus (a slight modification from its name prior to 2003, which
    was E.M.Power+). Our first peer-reviewed article was published in the
    December 2001 issue of the Journal of Clinical Psychiatry, along with
    an excellent commentary by Dr. Charles Popper from Harvard Medical School and McLean Hospital. A second article has been published in the Journal of Child and Adolescent Psychopharmacology. Additional confirmation of our results has been published in a Letter to the Editor of the Journal of Clinical Psychiatry, by Dr. Miles Simmons, of Maine. Another
    manuscript containing an open label case series in children was
    published in April 2004 in the Journal of Child and Adolescent
    Psychopharmacology.

    A formal placebo-controlled clinical trial has recently begun in
    Calgary, Alberta, Canada: it involves adults with bipolar disorder who live in the Calgary area. It is using the newer version of Empowerplus (as opposed to the one employed in all previous publications). You can read about the current study on its website: http://www.MoodStudy.com. If you would like to be on our mailing list to receive reprints of this and future articles,
    please send me your mailing address.

    The following are some additional facts that may interest you:
    The ingredients of this supplement are mostly ordinary minerals and
    vitamins. They are certainly not unusual or exotic: a normal everyday
    diet includes 34 of the 36 components, though not in such high amounts.
    A full daily dose initially consists of 5 capsules three times/day (=
    15/day). [Note: our publications thus far employed an earlier version,
    containing many more capsules.] Most people decrease that to a maintenance dose after a few months, usually at about 4 capsules twice/day (=8/day). The ingredients are not a secret: they are listed on every bottle, at the Truehope website mentioned below, and in our published articles.

    If you are a physician considering using this supplement for patients
    who are currently taking psychiatric medications, I urge you to read Dr.
    Popper’s commentary carefully.

    To purchase this supplement, the distributor can be reached at the
    toll-free number on the website (www.truehope.com), which is
    1-888-truehope (1-888-878-3467). That is also the phone number to call
    if you just have general questions about the supplement. The Truehope
    people are not medical researchers or even health professionals, and
    you will see that the website is written for the general public. The
    Truehope people have a system in place for talking with you and the relevant physicians about the use of the product. Although they do not have health professionals available to provide guidance, this “friends
    helping friends” system will be able to provide information that might be
    helpful.

    None of the academic researchers benefit financially from the sale of
    this product. None of us ever receives any money from the Truehope
    people.

    Thank you for your interest in our work. If you have any further
    questions about the academic research, feel free to write directly to
    me.

    Bonnie Kaplan


    Bonnie J. Kaplan, PhD
    Professor, Dept of Pediatrics
    Univ of Calgary, Alberta Children’s Hospital
    Phone: 403-943-7363 FAX: 403-543-9100

  • I am quite sure the rate of relapse after discontinuation of any psychiatric drug is inflated by the almost universal misdiagnosis of withdrawal symptoms as relapse.

    There are virtually no guidelines for tapering; we can be sure some of those who were observed to be relapsed in studies were discontinued too fast for their individual tolerances.

    In addition, of all the hundreds of clinical trials that involved observation (lasting only weeks) after discontinuation, I’ve seen exactly one that included a protocol to distinguish withdrawal symptoms from relapse. All the others — 99%+ of studies — use psychopathology scales for assessment. Any symptomology at all is going to be reported as a psychiatric condition rather than withdrawal symptom.

    The statistics for relapse are likely all incorrect. I would like to see some reporting based on slow discontinuation and careful observation of withdrawal symptoms during the process, and observation for at least 6 months post-discontinuation.

  • ScottW wrote: “I think we will be able to identify some discrete entities or at least categories which are similar enough to be meaningful. I can’t prove it yet, that is just what I think.”

    Yes, this is a matter of belief. Jay Joseph’s articles explain how history has proved this is unfounded. However, given the collapse of the “chemical imbalance” theory, psychiatry needs a scientific rationale, and millions of dollars are now being poured into genetic research and brain scans in psychiatry — all on the basis of belief, which becomes quasi-religious and impervious to evidence.

    If you look at the vagaries of diagnosis in psychiatry, you will see why “discrete entities” are unlikely to be found. That high-tech research is being done on heterogenous populations because disorders are so sloppily defined. The results of the research are, therefore, chimerical — dependent of the biases of the researchers.

  • To say that so-called psychiatric disorders have a biological basis because they occur in the brain, nervous system, and body — as all thoughts, feelings, senses, etc. do — is reductionism of the worst kind.

    Yes, there must be a physiological basis for thoughts, feelings, senses, etc. But that does not mean there is a physiological disorder or disease underlying specific thoughts, feelings, senses, etc.

    In fact, the “brain circuitry” proponents in psychiatry propose that disorder or disease underlies only those thoughts, feelings, senses, etc. of which they disapprove and have designated as “abnormal,” when they may not be abnormal at all.

  • Interesting. In my experience with (unfortunately) multiple psychiatrists and non-psychiatrists, they did not trouble to find out whether stress was a factor in my complaints.

    All of my doctors were chosen for their excellent (and, as I found out, undeserved) reputations.

    I was told on many occasions that my issue was a “chemical imbalance.” Prescriptions seemed reflexive and quite arbitrary — one internist told me “pick one, SSRIs are all the same.”

    My conclusion is that no one should even attempt to discuss emotional problems with an M.D. They’re not selected or trained to be particularly empathetic. Feelings make them uncomfortable. Their fingers get itchy for their prescription pads no matter what. They hear you whining and — boom — you’re on meds for life.

    ScottW, I disagree strongly that distinguishing genetic vs. environmental causes is not relevant to treatment.

    Historically, emotional states aka “psychiatric symptoms” caused by environmental factors tend to resolve spontaneously within a short amount of time. They do not require invasive treatment such as psychiatric medication, with its many added risks.

    One might say emotional distress is nature’s way of telling us to change our circumstances, not to take a pill.

    You seem to have profound faith in the medical profession and psychiatry research, although the latter has been shown to have been distorted by commercial interests for the last 30 years. It’s not nearly in the same league as neurology research into Alzheimer’s. Have you read Robert Whitaker’s Anatomy of an Epidemic?

  • Yes, exactly.

    A harsh withdrawal from antidepressants or benzos can also include symptoms mistaken for “psychosis.”

    The symptoms are not related to the drug but to the nervous system destabilization that follows from going off the drugs too fast.

  • Many commentators here are addressing relapse or treatment of “mental illness.” Some non-drug treatments are indeed effective.

    But it is crucial to differentiate between the iatrogenic condition induced by psychiatric drug withdrawal and natural neurological variation.

    For the most part, the symptoms of psychiatric drug withdrawal syndromes are caused by autonomic dysfunction of a type that is not seen in nature — except in cases of chronic exposure to toxins.

    The autonomic nervous system is as complex and mysterious as it is important, as it runs all the “automatic” functions of your body, such as heartbeat, blood pressure, digestion, etc. through a poorly understood web of feedback mechanisms. Dysautonomia can have an intense effect on cognition and emotion as well.

    Even cardiologists and neurologists only very, very carefully attempt treating the autonomic nervous system. When you “adjust” one area, it tends to cause disruption in another.

    You cannot treat psychiatric drug withdrawal syndrome as a psychiatric illness. It is not an emotional state, it is dysautonomia. This is why careful tapering to the tolerance of the individual is key to going off psychiatric drugs. Once autonomic dysfunction takes hold, recovery can take a very long time.

    There are no silver bullets for dysautonomia. For the most part, you have to adopt healthy habits that are gentle on your nervous system and wait for it to heal.

    I urge anyone who is concerned about getting people safely off psychiatric drugs to look at many, many case histories to see what’s involved.

    Don’t try to guess what people need from one case or a handful of cases, or from a theory of what might work. See what people who are trying to go off psychiatric drugs actually need by reading their stories.

    There are a couple dozen peer-run Web sites for psych drug tapering and about the same number of Facebook groups. Search by the name of the drugs, for example: “Seroquel withdrawal”, “Effexor withdrawal”, “Ritalin withdrawal”, “Xanax withdrawal”. You’ll see hundreds of thousands of posts from people who are going through withdrawal.

    To be sure, the ones who never had any problems going off their drugs are not posting on the Web. But if you’re planning a withdrawal program or are otherwise interested in the subject, you would be best prepared to understand the worst that could happen.

  • Daniel, “horrible” is an understatement!

    Please note that I posted the above on behalf of a correspondent. Personally, I don’t condemn occasional benzo use to deal with withdrawal symptoms post-discontinuation.

    Tapering should incur almost no withdrawal symptoms. Withdrawal insomnia indicates you’re tapering too fast.

    Rather than relying on benzos during a taper, if withdrawal symptoms occur, the safer thing to to is to slow the taper — hold on the taper or updose slightly, stabilize, and then reduce by smaller amounts.

    If withdrawal symptoms start, they’re probably going to continue through further reductions. Here’s where there’s a risk of depending on a benzo: You’ll be tempted to take them frequently.

    From my perspective, the danger of occasional benzos to deal with post-discontinuation withdrawal syndrome is that usually the person’s nervous system is sensitized to neuroactive substances (including supplements, alcohol, and marijuana) by withdrawal. Benzos can have a paradoxical effect and if this happens, it can make withdrawal syndrome worse.

  • Jonah, it appears we are in the realm of the hypothetical again.

    It’s a lot easier being an armchair philosopher speculating about what might be good for other people than it is to connect with them one-to-one and try to help them.

    There are many people suffering from post-discontinuation withdrawal syndrome on my site. If you think it would help them, you are invited to counsel them in your 12-step approach and see what kind of reception you get.

    Otherwise, no, I’m not going to recommend it to the people who come to my site. It doesn’t seem appropriate to me for the purpose of supporting recovery from psychiatric drug withdrawal.

  • Jonah, some people do find benefit in 12-step programs and some do not. The AA approach is quite controversial.

    Your own experience is entirely valid but may not be generalizable.

    I have experience with this population, many hundreds of people, and I have put forth my opinions above based on that experience.

    From what I’ve seen, pondering and rectifying one’s faults in the 12-step manner would only to the stress of withdrawal syndrome.

    Oh, yes, withdrawal does have adverse neurological effects. If you haven’t experienced the harsh emotions emanating from a nervous system destabilized by withdrawal, you are fortunate.

    If you’ve changed your mind and you’d like to provide support to people suffering from withdrawal syndrome and thus gain insight into what others are going through, please let me know.

  • A correspondent from a benzo withdrawal group on Facebook, a person “who survived benzo withdrawal and 6 years later, began to feel better,” asked me to post the following.

    This person wants to caution against regular use of benzos to counter withdrawal symptoms; benzos themselves incur physical dependency and can be difficult to taper off of.

    “I am beyond horrified that [Daniel Mackler] would mention taking benzos to “help” [withdrawal], for obvious reasons. While in post-benzo withdrawal myself for a few years, I was lucky if I could get out of bed.

    “I’m concerned for those reading his article that might think 1) taking benzos is ok, and 2) that they will feel more despair, shame, and guilt than they already do in drug w/d if they can’t “get moving” any faster than they are able.”

  • If there ever is such a thing as an inpatient withdrawal facility permitting tapering as long as it takes, I’d like to see it modeled on a health spa, complete with healthy spa food.

    As for the 12 steps, I don’t see why people who have suffered iatrogenic harm have to in any way blame themselves, try to purify themselves of evil, or focus on their shortcomings.

    What I’ve seen is that some people suffering in withdrawal try to figure out why the universe is punishing them — this must be an atavistic belief system in humans — and feel terribly guilty for every little error they’ve ever committed.

    (There also seems to be part of withdrawal syndrome, there’s something going on neurologically that unearths every painful memory you’ve ever had.)

    What I tell them in these situations is to forgive yourself and focus on taking care of yourself. Being pushed to this out of necessity often is a revelation and a spur to spiritual growth. Distressed people often seem to have self-neglect at the root of their troubles, and cherishing their own well-being opens them up.

    There is a punitive or moralistic aspect to 12-step programs and other addiction interventions that I do not believe is at all appropriate for people having difficulty in going off psychiatric drugs.

  • In response to Nijinsky’s post on February 28, 2013 at 8:41 pm:

    Yes, some people can fairly quickly go off drugs with few problems, but others have massive problems. It’s the luck of the draw. It can’t be predicted.

    It’s likely you heard from the lucky ones because the unlucky ones….well, they might not be getting out much….

    Withdrawal syndrome is not a matter of psychological dependency, it’s a neurophysiological vulnerability. Implying withdrawal is “all in your mind” is as cruel as dismissing any complaint of an adverse effect from a psychiatric drug.

    Tapering is a way to reduce the risk of withdrawal syndrome. Cold turkey is a way to dare the fates. Lose the bet and you can be suffering badly for a very, very long time.

  • Ran out of Reply buttons.

    In response to Daniel Mackler on February 28, 2013 at 7:02 pm:

    Daniel, I’m glad you’re thinking about this subject. Overmedication is so prevalent, affecting tens of millions, the problem of getting people off drugs without further damage to their nervous systems is huge.

    But we have to get beyond the hypothetical. (There’s a great deal of the hypothetical on MIA.) What can be done to help the many people who need this assistance now?

    First, I contend conceptualizing the solution as inpatient programs is going in the wrong direction. By its nature, gradual tapering takes too long to be an inpatient process.

    Funding such inpatient facilities all over the world would be an impossibility. The services need to be decentralized.

    The best way to get people off drugs is with localized resources: Educated doctors along with psychotherapeutic support.

    You need prescribers to write the prescriptions for tapering. These prescribers should coordinate with therapists supporting the person’s re-entry into non-medicated life.

    Educated prescribers are the scarcest resource in this scheme. How can we find them? If we have to train them, how can we reach them and train them?

  • Actually, people often end up medicated to the gills for no good reason.

    90% of those on psychiatric drugs in the US are on antidepressants.

    My hypothesis — which I believe would be confirmed by a study of systematic tapering — is the horror stories you hear of relapse are severe withdrawal syndrome from too-fast tapering. Those symptoms can include symptoms mistaken for psychosis.

    However, with all due respect to psychotherapists, there are many people going off their drugs without need for psychotherapeutic support.

    Many therapists, believing psychiatric drugs are essential to treatment, will discourage the person’s plan to go off.

    Going off drugs without tapering is risky, but going off drugs without a therapist is very doable.

    That said, supportive therapy is a very good thing to have while tapering, if only to work through the distrust for doctors the process engenders and the realization that one has wasted many years in a drugged haze.

  • Yes, it’s clear to me you assumed tapering was a given, and that’s why I’m so exercised about your post.

    Your assumption that “tapering is a given” is incorrect, and that you can simply get a psychiatrist on staff who knows how to do it — problem solved.

    The ignorance of the medical profession about tapering is why so many people are terrified about going off their drugs. They’ve heard stories of bad tapers, they might have had such experiences themselves, their fears are well-founded.

    Now, about one of the points you put forward above: “Gather detailed information from those who have tried coming off.”

    I’ve given you hundreds of case histories http://tinyurl.com/3o4k3j5 , scientific literature http://tinyurl.com/aqg3bjo , and even tips about tapering specific drugs http://tinyurl.com/42ewlrl

    It’s all tied up in a neat package for you. What are you and your colleagues going to do about it?

  • If by “systematically” you mean studies by medicine, you are correct.

    If we wait for some authoritative study to come out of psychiatry about the proper rate of taper, we will be waiting a very, very long time. The problem of withdrawal syndrome is widely denied by medicine.

    In the meantime, millions of people — I am not exaggerating — are at risk of improper tapering and developing long-term withdrawal syndrome.

    (Thus, peer support sites like mine offer the only tapering coaching available to many people. There are about a dozen or so such sites.)

    If we want any studies, we will have to do them ourselves. That is why I collect case histories here http://tinyurl.com/3o4k3j5 It behooves the MadinAmerica community to respect the knowledge of peer counselors like myself in this area.

    Allow me to explain why tapering, and not support, should be the focus of a withdrawal program. If the person develops withdrawal syndrome, a psychotherapist will be supporting someone with a chronic medical condition, not someone with a clear horizon for personal growth.

    I must stress — the major risk in psychiatric drug withdrawal is not relapse but withdrawal syndrome.

    Psychiatric drug withdrawal programs are misconceptualized as inpatient programs. You will not be able to get most people off psychiatric drugs in a few weeks or even a few months of inpatient care. The rate of taper should be tailored to individual tolerance, not to an arbitrary schedule set by an inpatient program (and insurance coverage).

    The addiction medicine model does not apply to psychiatric drug withdrawal. People do not have to be retained as inpatients to make sure they are going off psychiatric drugs. Usually, they are all to willing.

    Psychiatric drug withdrawal should be conceptualized as an OUTPATIENT service (with informed inpatient services available to the minority with extreme negative reactions to dosage changes; this is NOT available now). Clearly, it needs to be decentralized to serve the millions who need it. Who should do it? Individual physicians.

    How can psychotherapists assist in getting clients the medical help they need in tapering? First, educate yourself about the tapering process. Joseph Glenmullen’s The Antidepressant Solution is probably the best book on this subject (although I disagree with his rate of taper).

    Once you educate yourself about the process, you will be able to talk to physicians about it. Any physician you ask will claim to understand tapering; you will need to ask questions to find out how much the person actually knows.

    One red flag is a reliance on skipping doses to taper. If a doctor does this, he or she knows nothing about tapering.

    Find out from the physicians you have contact with who gets the concept of tapering. Share this information by putting these doctors on a central list that patients, therapists, and other physicians can see.

    Speak in your local and regional organizations about the need for careful, individualized tapering to get off psychiatric drugs safely.

    I’m sorry to be so grouchy about this, but I’m quite frustrated by the insistence that nothing is known about tapering because the doctors you know don’t know squat, and the genuflection to psychiatric mythology.

    Something is definitely known about tapering, and that is: Slower is better, withdrawal symptoms should be all but absent.

  • Jay Joseph, how would you interpret this latest study http://www.medpagetoday.com/Psychiatry/GeneralPsychiatry/37584

    Primary source: Lancet
    Source reference:
    Smoller JW, et al “Identification of risk loci with shared effects on five major psychiatric disorders: a genome-wide analysis” Lancet 2013; DOI: 10.1016/S0140-6736(12)62129-1.

    Additional source: Lancet
    Source reference:
    Alessandro Serretti, Chiara Fabbri “Shared genetics among major psychiatric disorders” Lancet 2013; DOI: 10.1016/S0140-6736(13)60223-8.

  • Daniel Mackler, thank you for bringing up this very important issue again. The difficulty of getting off psychiatric drugs shadows every discussion of non-drug alternatives.

    But — if I hadn’t been beating my head against the wall for years trying to educate about psychiatric withdrawal, I wouldn’t have believed you could leave out the MOST IMPORTANT aspect of safe psychiatric drug withdrawal.

    This should have been the first item on your list: Understanding what TAPERING means.

    As in your article, there is a lot of emphasis out there from psychologists on “support” for the person withdrawing, as if the only issue was the emotional distress of dealing with a changed situation or maybe relapse.

    But prescribers all over the world, including the vast majority of psychiatrists, are actively injuring people by not understanding even the basics of TAPERING.

    It’s a lie that withdrawal syndrome is mild and lasts only a few weeks. It can be very severe and last for years. It amounts to iatrogenic neurological dysfunction. The risk of withdrawal syndrome can be reduced by TAPERING.

    TAPERING means a gradual, progressive, systematic reduction in dosage. The consensus among peer support sites is that 10% is a rate of dosage reduction that minimizes withdrawal symptoms.

    People who are sensitive to dosage reductions may need to taper as slowly as 10% per MONTH, calculated on the last dosage (the amount of decrease gets continually smaller). People who are very sensitive may be able to reduce by only a fraction of a milligram per month or longer.

    Does this seem onerous? Psychiatric drugs are tremendously powerful. Read case histories here http://tinyurl.com/3o4k3j5

    If a person does not have the self-discipline to taper at 10%, even reductions of 10% per week are safer than decreases of 25% or more at any interval.

    (NEVER skip doses to taper — this is an old wive’s tale going around among doctors. It’s second only to cold turkey in eliciting terrible withdrawal symptoms.)

    Cutting up tablets, using liquid preparations, and customized prescriptions from a compounding pharmacy are a few ways you can accomplish gradual tapering.

    You say “helping people withdraw from neuroleptics in a systematic way is largely unexplored territory.” Excuse me???? I’ve got hundreds of pages of information about tapering here http://tinyurl.com/42ewlrl and symptoms here http://tinyurl.com/3hq949z Journal articles are here http://tinyurl.com/aqg3bjo

    I spend hours every day giving people tips about tapering.

    Let’s stop pretending that neuroleptic withdrawal is a black box. There is actually a great deal known about it. There are some big lies — that withdrawal syndrome is trivial and lasts only a few weeks is the biggest. I’m glad ChuckSigler mentioned “post acute withdrawal” syndrome — many people who believe they’ve relapsed after withdrawal are actually suffering from this.

    Prolonged withdrawal syndrome from psychiatric drugs is largely denied by psychiatry. David Healy is one of the very few authorities who have warned about it.

    There is no information about success and failure rates, as you mention above, because proper systematic TAPERING is so infrequent.

    As far as leaving TAPERING to the “good psychiatrist” you’ll have on board — try to find one. Very few psychiatrists know how to taper. I wish I were exaggerating. This is the only list of such resources that exists http://tinyurl.com/7cp8l8v and it was incredibly difficult to find them. (If you know of a doctor knowledgeable about tapering, please write me at survivingads at comcast * net)

    Here’s what patient advocates need to do to provide a safe avenue off psychiatric drugs: Educate themselves and doctors about TAPERING.

  • “The study will use new technology from CNS Response Inc., which will allow military researchers to track electrical activity in the brains of 2,000 troops and civilians suffering from depression. They’ll compare the results with thousands of others in the firm’s online registries, allowing experts to develop new treatment approaches.”

    Don’t count on this study showing anything about anything. It sounds like they’re going to get brain scans.

  • People get adverse reactions to antidepressants ALL THE TIME, get misdiagnosed with bipolar disorder — and then they’re off on the psychiatric medication merry-go-round for years and years.

    This is so very, very obvious. See case histories at http://tinyurl.com/3o4k3j5

    Withdrawing from drugs should, of course, be done slowly. Jeff, those periods of intense depression following your abrupt quitting of drugs might well have been from withdrawal. Withdrawal symptoms tend to resolve over time, sometimes years. You’re lucky that yours went away after 7 months.

  • I’m sorry, I’ve got to object to the presumption that having a range of emotions causes inflammation.

    Underlying medical conditions can, indeed, cause the inflammation that’s picked up by the studies purporting to show an association between inflammation and depression. And why shouldn’t someone who feels physically low also feel emotionally low?

    The association between inflammation and an emotional state is a confound, not causal. And if a physical illness is identified as a psychiatric condition, that’s just plain bad medicine.

    I also have difficulty with the idea that stress causes inflammation. That’s like saying life causes inflammation. So?

    Yes, extreme stress can cause all kinds of physical reactions, including inflammation. Normal stress is normal.

  • Dr. Middleton refers to Peter Jones’s statement: “Adult mental health disorders begin in adolescence.” and comments “In fact there is something intuitively obvious about it.”

    Yes, it’s intuitively obvious because it’s a statement of the obvious. Of course an adult mental disorder (if such exists) would have to have its origin somewhere in the past. Where else would it start? It can’t start in the future, and no one supposes such conditions are instantaneous.

    How about adolescent mental disorders? Must have started in childhood? And childhood mental disorders? Must have started in infancy? Infant mental disorders? Must have started with in the womb.

    Such reverse engineering of cause amounts to a tautology. Suicides — of course they were depressed, who else would kill themselves? Murderers — must be mentally ill, why else would they kill?

    This is psychiatry playing dumb to have something to talk about.

  • Just for the record: I didn’t post any ad hominems on the PLOS thread. I was not a troll then or ever.

    Based solely from my comments on the PLOS thread, Dr. Preda projected an unreasoning conspiracy theorist (a Scientologist???) that isn’t who I am.

    While this may indicate a hostile prejudice towards any non-doctor who does not agree with him online, I certainly hope he does not leap to similarly hasty unfounded diagnoses when working with his patients.

  • Whatever alternative coding is used for insurance reimbursement, an effective boycott of the DSM-5 would put a dent in APA finances and might get them to sit up and listen to critics (after the silverbacks stop pointing fingers at each other).

  • I agree, Dr. Preda himself corroded the discourse in the PLOS article comments with an ad-hominem rant about trolls.

    His initial foray was in response to a January 14 comment (mine) that pointed out Gibbons, 2012 was coming under very heavy criticism on the 1boringoldman.com blog. It was not inappropriate. Preda had cited Gibbons as a study overlooked by the media that “reminds us that it is our duty as physicians and society at large to carefully screen and aggressively treat depression, including with medications if so recommended.”

    Apparently Dr. Preda cannot abide any comments that are less than admiring of his thesis.

    But that’s a side show. Central to my point is that if highly credentialed Adrian Preda can be taken in by Gibbons, anyone can. This is an excellent example of how very, very shaky the foundation is for the prescription of psychiatric drugs.

    Yes, the media reports inaccurately, but much more important is that, when it comes to the evidence base, there is no there there.

  • There you have it. Dr. Preda has settled this debate for good.

    Regardless, any meta-analysis of published studies on antidepressant effectiveness is going to include a lot of corrupted studies biased towards antidepressant effectiveness. Meta-analyses of these studies is garbage-in, garbage-out.

    But perhaps that’s justification enough for psychiatrists — what else are they going to go on?

    From the Wall Street Journal January 17, 2008 (2008!!!) http://online.wsj.com/article/SB120051950205895415.html?mod=hps_us_whats_news : “The effectiveness of a dozen popular antidepressants has been exaggerated by selective publication of favorable results, according to a review of unpublished data submitted to the Food and Drug Administration.”

    See the chart in Wall Street Journal article, derived from Turner, et al, 2008 Selective publication of antidepressant trials and its influence on apparent efficacy, cited by 400 other papers.

    (Abstract at http://www.ncbi.nlm.nih.gov/pubmed/18199864; full text at http://www.nejm.org/doi/full/10.1056/NEJMsa065779#t=articleTop )

    Note the exaggeration of antidepressant efficacy in scientific publications ranges from 11% to 69% — certainly enough to overcome any measure of statistical significance indicating efficacy.

    Regarding Leucht et al, 2012, I would like to point out that medications for medical disease with so-so efficacy are used to treat actual biological dysfunction, and the risk-benefit evaluation in those situations is quite different from that when contemplating treating a “mental” condition.

    Among the differences, first and foremost, physicians treating a medical disease can tell when to discontinue drug therapy for lack of benefit. Second, their ethical code recommends trying lower-risk, preferably non-invasive treatments first before ratcheting up the risk level.

    Psychiatry follows neither of these practices, and because of so much bad research, clinical risk-benefit assessment of medication for an individual patient is arbitrary.

  • Given that the effectiveness of antidepressants is no better than placebo, ANYTHING might compare favorably with them, or at least on par with placebo.

    In fact, while a non-invasive treatment like CBT is vastly preferable to any drug, CBT itself has been found no better than placebo in many studies.

    Its current popularity has been a function of politics. Unlike other modes of psychotherapy, it is somewhat formulaic and lends itself to incorporation into study designs. Governments have funded many studies on CBT, creating a research base that permits it to be called “evidence-based.”

    In other words, another creation of biased research.

    Ultimately, the relationship with the therapist is the most important factor in effective psychotherapy, as summarized here http://www.nrepp.samhsa.gov/Norcross.aspx

    “The results of these 20+ meta-analyses converge into a series of research-supported conclusions with important implications for psychotherapists and clients alike (Norcross, 2011).

    The therapy relationship makes substantial and consistent contributions to patient success in all types of psychotherapy studied (for example, psychodynamic, humanistic, cognitive, behavioral, systemic).”

    Which makes sense — people experiencing emotional distress feel better when they believe others take a sincere interest in them.

  • So….how does the full quote refute my point?

    Further, your faith in CBT is supported by a similarly biased scientific literature.

    (Still, sending patients to possibly worthless CBT sessions is an improvement over reflexively prescribing possibly worthless psychiatric drugs with their attendant interference with healthy physiological processes, i.e. adverse effects.)

    Point being, the scientific literature is as questionable as media information. If patients refuse antidepressants based on faulty media information, they may simply be making the right choice for the wrong reasons.

    Given that in the US alone, about 90% of those taking antidepressants are taking them for reasons other than major depression http://www.cdc.gov/nchs/data/databriefs/db76.htm and many with no diagnosis at all, there is much improper prescribing of antidepressants.
    For most people with ordinary life problems, antidepressants are not a proper treatment, yet they get them anyway. Psychiatry keeps waving the bloody shirt of those severely depressed who are “scared away” from “proper” treatment with antidepressants, yet who’s to say antidepressants are the proper treatment for any individual?

    (From my personal experience with psychiatry, I would warn against not discussing one’s emotional problems with any M.D.)

    If mass media amplify scare messages, it also amplifies benefit messages. For years, pharma press releases drove the general public to ask for antidepressants from their doctors. Now the pharma money spigot has been turned off. Inaccurate scary stories are an antidote to inaccurate glowing benefit stories.

  • I see a more pernicious argument in Dr. Preda’s blog post: “….all is certainly NOT well if the patient’s decision not to accept treatment with antidepressants is based primarily on *media* delivered misinformation.” (Asterisks mine.)

    It’s not the media who are solely to blame!

    Dr. Preda implies that there is a better source of information about antidepressants — the information published in scientific journals, such as Gibbons, 2012, which he cites:

    “The Gibbons study reminds us that it is our duty as physicians and society at large to carefully screen and aggressively treat depression, including with medications if so recommended.”

    And yet, as pointed out by the former Emory psychiatrist who authors 1boringoldman.com http://1boringoldman.com/index.php/2013/02/05/thanks-to-robert-gibbons/ , Gibbons’s work is a poster child for how *scientific journals* deliver misinformation.

    In fact, 1boringoldman suggests the AllTrials campaign, which would require that all clinical trials be registered and reported so data from them would be public, was propelled by outrage over Gibbons’s egregious distortions.

    It’s not just the media which, for its own reasons distorts information about psychiatric treatment, but psychiatry itself — again for its own reasons. What does the media have to work with? Even the best reporters wouldn’t have been able to unravel Gibbons the way it needed to be unraveled, see http://1boringoldman.com/index.php/2012/04/15/an-anatomy-of-a-deceit-4-the-letter/

    In January 2013, after a lot of balking, JAMA Psychiatry published two letters critiquing Gibbons, 2012, their signatories including David Healy and Bernard Carroll. You can read them here http://1boringoldman.com/index.php/2013/01/03/persistence/

    How could the media have discovered the confounded nature of the studies underlying Gibbons, 2012? It took a tremendous amount of digging in the clinical trials databases, comparison of published and unpublished trials, correspondence with uncooperative pharmaceutical companies, and, finally, independent statistical analysis.

  • Just for the record, several of my comments on the PLOS article that had been published have been de-approved (visible to me as “awaiting moderation”). I presume Dr. Preda is responsible.

    ———–
    February 6, 2013 at 5:59 pm

    It is quite easy to reconcile Leo and Lacasse regarding distortion in the mass media and journal articles.

    Both are unreliable when it comes to psychiatric drugs, for different reasons. Supposedly scientific articles are contaminated by pharma influence and empire-building (and empire-defending) by their authors, cf Gibbons.

    Even compensatory mechanisms such as Cochrane reviews merely blend results of good studies and bad studies — garbage in, garbage out.

    Media accounts rarely look under the hood of press releases and exaggerate findings to make a good story.

    There is much to criticize both in questionable practices in journal articles and in the mass media. It does not take a huge intellectual leap to understand this.
    ———–

    February 7, 2013 at 1:26 am

    Dr. Preda, I do not at all propose a conspiracy theory. To some extent, the two phenomena arose independently, from different causes and motivations — as I said.

    However, your interpretation of my good-faith comment again displays your own prejudices and excessive defensiveness regarding critics of psychiatry.
    ———–

    February 7, 2013 at 1:43 am

    And I agree with CannotSay2013 that Dr. Preda’s assertion that “your attitude is unfortunately typical of anti-psychiatry troll comments” is in itself a very good example of an ad hominem — combined with a straw man argument.

    Dr. Preda, your style of defense tends to discredit itself. Words to the wise: When you’re in a hole, stop digging.
    ———–

    February 7, 2013 at 3:46 am

    I got an e-mail alert of cannotsay2013′s missing comment, February 6, 2013 1:13:43 PM PST. Entire text as follows:

    Author: CannotSay2013
    Comment:
    Again, “your attitude is unfortunately typical of anti-psychiatry troll comments” is another fallacious ad hominem attack.

    [….and so forth, as reposted above]

  • My problems with Adrian Preda’s comments on the PLOS article are

    1) Their logic is poor.
    2) He freely uses ad hominems, straw men, guilt by association, false dilemmas, and other rhetological fallacies to defend his case, which makes it appear all the weaker.

    The more he comments, the more he casts doubt on the credibility of his argument. Such is the court of the Web. It’s all there in black and white.

  • I got an e-mail alert of your comment, cannotsay2013, at February 6, 2013 1:13:43 PM PST. Entire text as follows:

    Author: CannotSay2013
    Comment:
    Again, “your attitude is unfortunately typical of anti-psychiatry troll comments” is another fallacious ad hominem attack. Your rebuttal is not based on logic, since you didn’t address the substance of the MIA comment with respect to the attitude of the media in the sense of promoting antidepressants. You just said that the authors a few years ago had a different opinion on the whole “media approach” issue. That’s an ad hominem attack combined with non sequitur. As I said, it’s typical of psychiatrist because you are just too accustomed of getting a pass for fallacious logic.

    The only difference between psychiatry and astrology is that historically speaking psychiatry has been used by the powers that be to get rid of those that the powers that be determined to be undesirable be it blacks who didn’t want to be slaves (Drapetomania) , women in the Victorian era that didn’t do what their husbands wanted (Hysteria) or more recently homosexuals. The powers that be are not about to get rid of this political power. As long as there are greedy psychiatrists willing to bow to them, there will be psychiatry. Unfortunately for you however, we have almost 40 years of SCOTUS case law that, at least in a US context, have limited your ability to do damage, which is why in the US psychiatrists prey almost exclusively on foster children, criminals and the elderly. It’s unfortunate that that’s the case, but that’s better that the kind of power those of your kind had in the USSR (or your native country before the fall of the Berlin wall).

    Psychiatry is not based on science for true science is not build on consensus (as the DSM is). It’s build on the scientific method. To this day, there is not a single biological marker of any kind that can be used reliably to diagnosis presence or absence of “mental” disease.
    I am a scientist with better credential than yours and let me tell you that in my field those publishing the type of rubbish you publish would be automatically expelled from the ranks. That’s your ugly truth.

  • Whatever Critical Psychiatry might be, it is definitely not a resource for people who want expert advice about tapering off psychiatric drugs.

    Critical Psychiatry holds the eccentric notion that withdrawal symptoms are psychological or psychosomatic and that patients need to be “talked through” their fears in order to go off psychiatric drugs.

    Here’s Duncan Double of Critical Psychiatry on the topic http://criticalpsychiatry.blogspot.com/2013/01/the-challenge-of-reducing-and-stopping.html and http://criticalpsychiatry.blogspot.co.uk/2012/09/what-does-it-mean-to-say-that.html (read the comments).

    As indicated on support sites like mine at http://SurvivingAntidepressants.org, patient experience is that minimizing withdrawal symptoms is dependent on tapering at a rate the individual can tolerate. Few psychiatrists or non-psychiatrists offer expertise in tapering. To my knowledge, because of its conceptual block in understanding withdrawal syndrome, Critical Psychiatry offers nothing in this regard.

  • Yes, the psychiatrist’s interpretation of the patient’s world does indeed matter. Patients are all too vulnerable to the opinion of the “expert.”

    For example, Dr. Thomas, here is your colleague in Critical Psychiatry, Duncan Double, doing his best to assert antidepressant withdrawal syndrome is a psychological phenomenon, rather than iatrogenic neurological dysfunction http://criticalpsychiatry.blogspot.co.uk/2012/09/what-does-it-mean-to-say-that.html and http://criticalpsychiatry.blogspot.co.uk/2013/01/the-challenge-of-reducing-and-stopping.html (read all comments on the two blog posts).

    This is in opposition to what patients say about their symptomology. For many case studies, see http://tinyurl.com/3o4k3j5

    As long as psychiatrists refuse to see their patients are truly injured by too-fast tapering, and instead blame the patient for the symptoms, those injuries will continue.

    There are hundreds of thousands of posts all over the Web about how doctors try to impose their version of reality on patients suffering from withdrawal symptoms. The result is a loss of trust in the expertise of even otherwise sympathetic psychiatrists. What you want to believe is true is simply not true.

    I understand Critical Psychiatry’s position is that withdrawal syndrome is a psychological or psychosomatic phenomenon. Duncan Double refers to the opinions of other DOCTORS to support this argument, rather than referring to actual patient experience.

    I suggest you and your colleagues in Critical Psychiatry listen more closely to what patients have to say about this issue. You might call this user-led research (http://bjp.rcpsych.org/content/180/1/1.full).

  • Case in point: Leaky gut. Is “depression” (universally poorly defined) a cause or consequence of leaky gut? Is the inflammation a result of leaky gut or emotional stress?

    Is leaky gut due to emotional stress or eating too much junk?

    For many people, bad habits or unhealthy lifestyle lead to physical conditions that may cause them to feel sub-par emotionally.

    Given evolution’s investment in negative emotions, wouldn’t you say organisms are stocked with them for a good reason? Don’t they indicate a situation that should be escaped?

    If, for example, people stay in distressing situations until they get sick, wouldn’t that be a cultural pattern rather than a biological imperative?

    I strongly question the inflammation theory of “depression.” First of all, it depends on what you call “depression.” (Anthropomorphizing animal models — what could be the fallacy in that?) Second, cause and effect are not at all clear.

    The theoretical setup smells fishy to me, and more of the same ol’ propaganda from biopsychiatry empire-builders.

  • According to this article http://dailycaller.com/2013/01/16/forbes-withdraws-online-essay-blaming-psychiatric-medications-for-sandy-hook-shooting/ , Forbes pulled the article because of the reference to CCHR.

    “Larry Hunter, chairman of former Texas Rep. Ron Paul’s Revolution PAC, wrote the essay. He told The Daily Caller on Wednesday that the financial news outlet removed his column from its website because readers complained that he cited sources affiliated with the Church of Scientology.”

    Lawrence A. Hunter’s blogs:

    http://socialsecurityinstitute.com/blog/it-s-the-drugs-not-the-guns

    http://patientoptout.com/email/muslims-get-to-opt-out

  • While all of medicine is overly influenced by commercial interests, only psychiatry is so thoroughly contaminated, from diagnoses to treatments to denial of adverse effects.

    (I would agree that the patient has to play defense and do a lot of research before accepting any recommendation for any drug or treatment.)

    littrell, I posted this question to you elsewhere. perhaps you can explain this to me. I’ve been looking for clarification everywhere.

    Can you tell me how grieving, for example, becomes depression after a couple of weeks? What is the model based on the inflammation theory you espouse?

    Further, is it possible the inflammation theory has arisen to fill the vacuum of the discredited “chemical imbalance” theory, to provide a justification for the prescription of psychiatric drugs on the grounds of improving physical health?

    I’ve looked at the studies and it seems to me they are all confounded by the possibility of subclinical or co-existing physical illness. People who feel lousy (from inflammation) might complain of symptoms (feeling low, fatigue) that may be misdiagnosed as “depression” and mistreated with psychiatric drugs.

    Throwing psychiatric drug prescriptions at unrecognized physical problems happens all the time, particularly for middle-aged women. Could this not be so common it would contaminate any studies on “depressed” people, finding inflammation not related to the “depression” but to the physical ailment?

    The research grounding for the inflammation theory seems to me to be motivated by a need to keep the bio in biopsychiatry rather than an interest in patient health.

    So what is the continuum from grief, a normal emotional reaction, to “depression”? The theoretical underpinnings for the DSM-5 entry holds the symptoms of the two conditions to be identical.

  • Thanks for keeping the searchlight on the U of Minnesota and the Dan Markingson case, Carl.

    Were there other patients injured by these studies? Probably yes, but psychiatry — research and clinical — does not answer for injuries on its watch. For a psychiatrist to be held responsible for patient injury, he or she darn near has to kill a child.

  • Carl Elliot asks, “Why is the General Counsel defending the actions of a pharmaceutical company? In fact, why is the General Counsel involved in an academic matter at all?”

    Because this is the best way to make the complaint go away.

    When you send a complaint through channels, this is one possible result: Bureaucratic stonewalling.

    After this, the next step is to get some prominent person involved and make a big public fuss about it. Behind the scenes, a contact takes the complaint to the university president.

  • Pharma engineered a cultural shift about “depression” in the US and Europe as well.

    Comparing models of “depression” across cultures highlights the destructiveness of the Euro-American one, which undermines individual autonomy and resiliency, replacing them with helpless dependence on drugs and “experts” and the expectation of endless treatment.

    I’m not an expert in cultural psychiatry, but it seems to me this model is quite malign. It does continue to generate profits for pharma, though, as people on chronic psychiatric medication, suffering side effects and thinking of themselves as forever ill, seek additional medical treatment for iatrogenic and other ailments.

    For example, psychiatric medications are a bonanza for diabetes treatments; metformin is being repurposed as an add-on for antipsychotics. Psychiatric medications often necessitate the use of sleep drugs. Iatrogenic stomach issues are treated with PPI drugs. And so forth.

  • littrell, perhaps you can explain this to me. I’ve been looking for clarification everywhere.

    Can you tell me how grieving, for example, becomes depression after a couple of weeks? What is the model based on the inflammation theory you espouse?

  • An underlying lack of nutrients become very clear in people suffering withdrawal syndrome after too-fast discontinuation of psychiatric drugs.

    Symptoms such as brain zaps — thought to be a type of Lhermitte’s sign or epilepsy — are often relieved by taking 3,000-4,000mg EPA+DHA fatty acids in good quality fish oil (usually 6 capsules) per day.

    Magnesium in easy-to-absorb forms such as magnesium citrate in small doses throughout the day takes the edge off anxiety.

    People often become hypersensitive to sugar and food additives, or have digestive problems, and take care of themselves by eating fresh foods with plenty of greens.

    In my own case, in the midst of severe Paxil withdrawal syndrome, I responded dramatically to vitamin B12 shots. I had been taking the stomach-coater Zantac for several years (for no good reason, it turned out) and, as I was over 50, it exacerbated the age-related natural decline in B12 absorption.

    (Unfortunately, withdrawal syndrome often incurs neurological hypersensitivity and some people cannot even tolerate nutritional supplements, particularly the neuroactive B vitamins. They have to carefully build up their nutrient balance through food only.)

    Across the board, one wonders if these nutrient deficiencies and the usual modern factory-produced diet might drive people to seek psychiatric medications in the first place, and then weaken their nervous system to be vulnerable to withdrawal syndrome when they quit.

    Dr. Brogan writes: “It became clear to me that studies that demonstrated high rates of relapse might reflect a phenomenon of pulling the rug out without checking the floorboards beneath.”

    None of those studies demonstrating high rates of relapse after discontinuation of psychiatric medication included protocols to distinguish relapse from withdrawal symptoms. ALL of that relapse information is confounded by misdiagnosed withdrawal syndrome.

  • Dr. Thomas writes: “…although to all intents and purposes he was on such a minute dose that it seemed improbable that it could be having any significant physiological effect upon him. But that wasn’t important. What mattered was how Bill felt on the dose….”

    From my experience over 8 years of counseling people tapering off psychiatric drugs and experiencing withdrawal symptoms, some people are very sensitive to very low doses of medication and very small reductions in those doses.

    You would have saved Bill and Zoe a lot of confusion and suffering if you had respected his report of withdrawal symptoms after dropping the .5mg dose rather than deciding ex cathedra that the dosage was insignificant and dismissing his reaction as psychological.

    I find it bizarre that psychiatrists cannot envision smaller dosages than are provided by pharmaceutical manufacturers.

    What people do in these situations is cut up the tablet or have the medication compounded into a liquid and titrate dosage using a 1mL oral syringe, which allows reductions of .01-.02mL, depending on the brand.

    When people are sensitive to tiny dosage changes, as clearly Bill was, alternating dosages, to which you resorted at the end, can also cause withdrawal symptoms, such as sleep deterioration or overstimulation.

    Note he recovered by updosing to the previous dosage at which he was stable.

    I am happy to hear that Bill’s nervous system finally stabilized from the erratic dosing you recommended and he was able to quit his drug regimen.

    Please be aware that more careful and attentive tapering can ease a patient’s way off psychiatric medications.

    PS You write: “‘That’s amazing’ I said ‘All the evidence says that such a low dose is ineffective. But I’ve occasionally seen it before in other patients….” By the way, the “evidence,” all derived from drug company trials, is wrong. Very low doses of psychoactive substances can indeed have a noticeable effect in human beings. Critical psychiatry needs to be even more critical!

  • My brother did some very disruptive acting out and I can tell you it was because of the intense dysfunction in my family. All of the children were scarred in different ways.

    I don’t mean to blame the mother in these situations, either, but I agree with Seth Farber, there’s probably something gone awry with the family dynamics. “What’s wrong with Michael?” is likely something he can’t voice without implicating both of his parents.

  • As you can imagine, 8 years of recovery is quite a saga.

    I can say at least for the first 4 years, the symptoms were grueling but recovery was gradual but progressive. However, in the 4th year, I made a mistake, I didn’t take care of myself and got myself into a very stressful situation which caused a major setback generating a severe sleep disorder.

    I have been recovering from that over the last 4 years.

    I’m 62 now; I think younger people might recover faster.

    I run a peer support site for tapering and prolonged withdrawal syndrome http://survivingantidepressants.org Please register and share your story with us.

  • This testimony is so important, and I’m glad that a writer with your skills, Matt, has produced it.

    Ordinary language, even that of medical diagnosis — “depression,” “anxiety,” “panic,” “tremors,” etc. — falls short of describing the horrors of withdrawal syndrome. But in part of a sentence, you capture so much:

    “Sleeping two hours a night, vibrating constantly like a half-busted refrigerator, barely able to converse or make eye contact, sweating, sheathed in muscular rigidity, panicking, too weak and fatigued to exercise, too distracted to read even a simple magazine article….”

    and I’m sure this was only part of your journey to recovery.

    Thank you for posting this. I look forward to your book. I hope it puts the perils of psychiatric drug withdrawal and the lack of knowledge of the medical profession about it in the public spotlight.

    And, that the unimaginable hell will end, eventually — so important for all sufferers to know.

    After 8 years, I’m coming to the end (I hope) of my recovery from Paxil withdrawal syndrome myself.

  • Ivana, many doctors know something about tapering, though they are still too few and very difficult for people to find.

    As I said before, only one or two doctors in the world treat POST-DISCONTINUATION WITHDRAWAL SYNDROME. If you know of any others, I would like to hear of them at survivingads at comcast dot net

    If tapering is too fast, after the last dose withdrawal syndrome can continue, intensify, and last for many months or years. That is the PROLONGED WITHDRAWAL SYNDROME of which I spoke.

    It is widespread nervous system or autonomic dysregulation, usually invisible on any tests.

    (Prolonged withdrawal syndrome may also occur after benzo withdrawal.)

    Some doctors, illogically, think withdrawal symptoms only occur during tapering. This is untrue. After discontinuation, withdrawal symptoms may persist and get worse, coalescing into prolonged withdrawal syndrome.

    Tapering should be conducted to minimize withdrawal symptoms throughout the process, lessening the risk of prolonged withdrawal syndrome when tapering is over.

    Thank you for this opportunity to clarify the concept of prolonged withdrawal syndrome.

  • Paula, I suggest you enlist Allen Frances in your cause.

    One of the bases of the complaint seems to me to be conflict of interest by the APA: The APA produces a quasi-medical diagnostic manual that generates business for its members.

    This would not be the first time anyone suggested the expansion of the DSM is related to empire-building for psychiatry.

  • When people wonder what they can do as individuals to change things for the better, I believe educating your doctors can be very effective.

    Each one, teach one.

    I know how very difficult this is. We don’t want to go back to the people who hurt us. We’ve lost respect for them and we feel betrayed.

    If you can let some time go by and you can approach your doctor without fear and rage, this can be very effective. (Revenge is a dish best eaten cold.)

    If you are angry and accusatory, the doctor will write off whatever you have to say as evidence of mental illness. Instead of listening, he or she may start to think of liability issues, become non-communicative, and withdraw from the conversation as fast as possible.

    Don’t expect your doctor to admit he or she was wrong. If you can just get your doctor to listen, the next time a patient like you shows up, it will ring a bell.

    A calm, straightforward letter works fine, too, and it might help get some of the anger out of your system. (In the US, send a copy to your state medical board.)

  • Dr. Sacks’s empathy is obvious from his writings, which are well-worth reading. He is an excellent writer.

    He is very skeptical of psychiatric medications because, as I recall, he believes they interfere with the person’s experience of his or her own life, and with creativity.

    I can’t recall anything he’s written specifically about schizophrenia. As a neurologist, he is a student of neurological diversity — his books very insightfully describe the inner lives of people with various kinds of true neurological damage. One of his themes is how they cope, recounted with great compassion and warmth.

    The world could use a lot more people like him.

  • Thank you, Stephen, I agree. (My site is back online now.)

    Unfortunately, people who are injured by too-fast tapering and cold turkey — people who have prolonged withdrawal syndrome — find support only among others who have suffered similarly.

    Few doctors even recognize the condition; only one or two in the world even attempt to treat it.

    Doctors, family, friends, therapists — they all tell people who are suffering from withdrawal syndrome that it’s “all in their heads” or they’ve relapsed or developed some new, exotic psychiatric disorder that doesn’t match any known symptom pattern (they’ll call it bipolar NOS or conversion disorder or PTSD or psychosis — anything to justify throwing a bucketload of drugs at it).

    As I mentioned before, there is also a faction of psychiatric activists who deny, minimize, or ridicule withdrawal syndrome because it doesn’t fit into an ideology of “throw aside your crutches and be cured.”

    Yes, you can get beyond the crutches, but there’s nothing easy or safe about these drugs, including exit.

  • terasinc, we substantially agree.

    However, I don’t think the terms “withdrawal,” “tapering,” or “cold turkey” imply anything about what happens after the last dose of medication. Sometimes there’s a “return to baseline,” sometimes not.

    Yes, the world would be a better place if everyone could find support for coming off. Sadly, many cannot, not from doctors, therapists, family, or friends. The Web support sites are all they have, if they manage to find them.

  • Adding to my list above:

    7) Will — please explain how your Textbook of Modern Community Mental Health Work will explain reinstatement of medication if withdrawal symptoms appear.

    This is the only way known to diminish withdrawal symptoms, aside from prescribing benzos, which is what many doctors do, of course leading (if they work) to dependency and withdrawal issues of their own.

    However, reinstatement sometimes does not work, and benzos sometimes cause paradoxical reactions, making unbearable withdrawal symptoms even worse. In these situations, doctors will often diagnose relapse or emergence of a new psychiatric disorder and throw the kitchen sink, drug-wise, at it.

    So you have a person who maybe went off one drug too fast, gets withdrawal symptoms, and ends up trapped on polypharmacy with an escalated but phony diagnosis.

  • Sandy, I just saw this.

    Thank you for taking care of your patients by getting them off drugs in a compassionate way, and for doing this study.

    What I’ve seen is people generally tolerate smaller dosage decreases better. A 25% drop is going to flush out those who are sensitive to dosage changes — this isn’t good.

    My suggestion: Trial decreases of 10% per month for 2 months.

    If no withdrawal symptoms appear, speed up to 10% decreases every 3 weeks; further acceleration could be a 10% reduction every 2 weeks, then every week.

    The 10% reduction is calculated on the last dosage. The absolute amounts of decrease get progressively smaller.

    The reason the trial period last 2 months is because, contrary to common belief, withdrawal symptoms sometimes take weeks to emerge and you don’t want to exceed the person’s tolerance for dosage changes.

    The reason the most rapid taper is 10% every week is to allow observation time to slow down if withdrawal symptoms appear.

    The most rapid taper works out to about 6 months.

  • Vanessa, there is no evidence that withdrawal syndrome is predictable.

    My guess is it has to do with — yep — neurological diversity, but characteristics so complex and subtle we will never be able to identify them for predictive purposes.

    It has to do with the way the drugs latch on to the individual nervous system.

    People who are on drugs shorter than 2 months seem less at risk, but some still suffer withdrawal after cold turkey.

    A few drugs, such as buproprion, seem less likely to produce withdrawal symptoms, but some get them anyway.

    Medicine has a strong belief that lamotrigine has no withdrawal syndrome, but many have found this is a joke.

    I agree with you, research that might predict who would get withdrawal symptoms might be very valuable. As I’ve said, researchers have been calling for this for 30 years.

    In the meantime, millions are on drugs, and I personally want them to get off safely and get as far away as pharmapsychiatry as they can. My conclusion is that tapering is worth the inconvenience and cold turkey is an unacceptable risk.

  • I’ve always had nothing but respect for Will, his work, and his writing.

    I also have done a great deal of writing about withdrawal. I consider Will a peer.

    I understand the concept of diversity and I completely support that, too.

    But cold turkey is like unsafe sex with strangers. You might say unsafe sex is part of the diversity of sexual practice. A lot of people are still attracted to it.

    Many people get away with unsafe sex, but some do not.

    Fortunately, infection with an STD or HIV is not the death sentence it was, but there is no cure or treatment for severe and prolonged withdrawal syndrome, or medical care, or even, as you can see in this discussion, recognition among psychiatric survivors or activists.

    So what kind of choice is “cold turkey” for people on psychiatric drugs? If you want to get out of the system, you risk being trapped in withdrawal syndrome and lacking self-determination for a very long time.

  • Emily, every day someone comes to my site who’s cold-turkeyed and suffering terribly, and begs for a solution.

    If they’re very lucky, they can reinstate the drug. This does not always work. The person then is in for many months, maybe years, of recovery from withdrawal syndrome.

    These situations are heartbreaking. They could have been avoided. But, for one foolish reason or another, these people have asserted their “right” to cold turkey.

    Unlike other peer support sites (such as paxilprogress.org), which discourage such members because, gosh, they’re just too darn depressing, I’ve committed to support people with prolonged withdrawal syndrome.

    Doing support of this kind is hard, hard work. Misguided recommendations to cold turkey if you feel like it only makes it more difficult.

    I can hardly wait to see how Will, Dr. Falk, and Dr. Fisher describe the downside of cold turkey in their forthcoming book, so people who consider this option will be fully informed.

    Maybe “You break it, you own it, you take it home” could be a chapter title.

    If you’d like to share my reality, Emily, you might read a few of the stories at http://tinyurl.com/3o4k3j5 Would you like to be a guest moderator and support these folks?

  • Not at all, Chrys. Like markps2, you haven’t suffered post-discontinuation withdrawal symptoms and you are attributing them to psychological causes.

    “I didn’t think the anti-d worked so had no problem in coming off it…” is the nut of your misconception. You imply belief in the drug is what causes others to experience withdrawal difficulty.

    (The rest of your quoted post is not relevant to that opinion.)

    Those of us who have experienced those withdrawal symptoms are not speechless lab animals. We can tell you and markps2 (and Duncan Double) that your speculations about what we feel are wrong.

    I would think that as a patient advocate or psychiatric activist, you would respect that.

  • In the context of a post by Duncan Double at http://criticalpsychiatry.blogspot.com/2012/09/what-does-it-mean-to-say-that.html , in which he claimed antidepressant withdrawal symptoms were psychosomatic (the drugs causing psychological dependency)

    Chrys Muirhead said (6 October 2012 07:56)…

    “Anonymous you may be right about anti-d’s being addictive for some. I’m not sure.

    It may be more about what a person thinks about the pill they’re taking and the power it has. Eg if they think it made them feel better then they might be fearful of coming off it, for then they could become unwell again.

    For me, I didn’t think the anti-d worked so had no problem in coming off it….”

    Your position being: It’s one’s belief about the drug that causes withdrawal symptoms, an “all in your head” argument.

  • Will, this blog post is so uncharacteristic of you. The point is muddled, the argument is weak, and it seems to have a politically motivated hidden agenda to please the cold-turkey faction.

    Point by point, my apologies for the length:

    1) Straw dog #1: The groundless protest against somebodies using the term “medication tapering.” I don’t know of anyone who thinks “withdrawal” and “tapering” are synonymous. As I understand English usage, “withdrawal” is the general and “tapering” and “cold turkey” are subsets.

    I don’t understand why you pasted this onto the top of your article, unless your intention was to claim yours is only a semantic argument, which it most certainly is not.

    2) Your second paragraph is a Trojan horse, where you introduce cold turkey as a reasonable withdrawal technique.

    3) You then refer to your upcoming “Textbook of Modern Community Mental Health Work.” All well and good. The advice about abrupt withdrawal in serious adverse events conforms to medical guidelines (and I’ve read, many, many medical guidelines about withdrawal). As I’ve said above, no one would argue with that.

    Please post the section of your book describing “the possible consequences of abrupt withdrawal” for the clinicians who are the audience for your book.

    Or do you assume they know? They don’t.

    (Note: “Lamotrigine” is misspelled. The last sentence of the selection runs on and needs to be rewritten: What the heck does “and any difficulties encountered met are treated as a learning process” mean? This seems rather important, as it would deal with post-discontinuation withdrawal syndrome.)

    4) The next paragraph moves further into “cold turkey as a withdrawal technique” territory, defending it as an aspect of diversity.

    Diversity, please. This plays on the general human inability to assess probabilities. I’m sure you understand distribution of response, even though the faction this is intended for might not.

    You don’t know which way cold turkey will go for you until you do it. It’s like Russian roulette. Five chambers are empty, but the sixth contains a bullet. Do you like those odds?

    5) Your last paragraph and close are a waffle. Did you say what you just did? Or maybe you didn’t mean it? Disingenuity alert!

    Can you please tell me when this “research into the physical risks of medication withdrawal and how to avoid those risks” might be done? The scientific literature on withdrawal (maybe 500 papers) has been calling for this for 30 years.

    6) Straw dog #2: On November 10, 2012 at 3:44 pm in a lengthy comment, you claimed, hypothetically, your roommate might have been killed by warnings against cold turkey she might have read on a peer support tapering Web site.

    I’m glad your roommate went right off lamotrigine and her life saved (by a doctor? another roommate?).

    Allow me to point out: No Web site threatened your roommate’s life. It was endangered by a doctor who prescribed an excessive dosage of Lamictal and, probably, ignored the danger signs for too long.

    You cannot pin your roommate’s endangerment on tapering Web sites and advice not to cold turkey. The problem is not “medication tapering” but medicine’s focus on “maintenance” despite the patient’s deterioration.

    The Web is full of good and terrible information. Your Googling roommate might have ended up taking advice from a naturopath, for example, and embarked on liver cleansing instead of quitting Lamictal.

    If people are Googling and seeking advice from other non-doctors on the Web, what it demonstrates is they don’t trust the advice they get from doctors. As we all know, the level of knowledge in medicine about adverse effects is abysmal and about withdrawal, even lower.

    Peer support sites for tapering and withdrawal exist because people can’t get this help from doctors. It’s not there. Nada. Zero. A VACUUM.

    Anyone, including Peter Breggin, who kicks the can of getting people off drugs to medical professionals is living in an alternate reality, not of this Earth.

    No, peers don’t offer the level of care you might get from a knowledgeable physician, if you were able to find one, and you should assess all peer advice accordingly.

    But your accusation that such tapering advice is destructive and, I gather, an affront to withdrawal “diversity,” is a gratuitous drive-by slur on peer support sites, one of which I run.

    Everybody has a vested interest in believing withdrawal is a lot safer than it is, particularly a faction of psychiatric activists who think tapering is a plot against the God-given right to cold turkey.

    And — allow me to close with this. Proponents of cold turkey never, ever show up to clean up the mess. If you think cold turkey is as good way a way as any to go off psychiatric medications, here’s an offer for you:

    Send e-mail to me at survivingads at comcast dot net and I’ll make you a guest moderator on my site. You can counsel the people who’ve cold-turkeyed. Maybe you can explain to them their intractable suffering is merely withdrawal “diversity.”

  • Will, of course deciding how you’re going to go off is a personal choice. You make the decision to convey the pill to your mouth.

    Before deciding how you’re going to go off, you should know the worst possible case, which is: Push your nervous system far enough, and it will break.

    Withdrawal symptoms are not benign. They are signals from your nervous system that something is going wrong. Once you push it into severe withdrawal syndrome, it can take a very long time to recover.

    Then you really do have a chronic neuropsychiatric disorder.

    Your nervous system is not immaterial, like your soul. It runs everything in your body: Your heartrate, your digestion, your sexual response.

    Don’t screw it up if you have a choice.

    If you’re having an adverse reaction, you need to weigh the severity of the reaction — which also indicates nervous system distress — against the potential damage you might do with cold turkey.

    If the adverse reaction is life-threatening or unbearable, the scales are tilted towards quick exit.

    Otherwise, you will want to protect your nervous system by going off gradually to minimize withdrawal symptoms.

  • “Pulling a band aid off fast or quickly” — not to dismiss your success with this method of withdrawal, markps2, but you were lucky that cold turkey worked for you.

    You would be singing quite a different tune if it didn’t.

    It’s a fantasy that one can cold-turkey and, at worse, suffer intense symptoms for a short time.

    That’s not nearly the worst. The worst is suffering intense symptoms for years, not weeks.

    Cold turkey is a risk. You might succeed at it, but you might not. You can’t tell in advance. If it goes bad, there is no cure, other than time, for what you’ve done to yourself.

    You may think you’re making a fast jailbreak from the mental health system, you may think you’re going to tough out withdrawal symptoms, but you’ll end up going from one quack to another looking for treatment.

    You may end up as one of those people who posts on Web site after Web site, on Yahoo and Topix, begging for help.

    Yep, you came through it okay, and I’m glad for you, but your doppelganger just signed up on my support site and sent me a personal message begging me for advice, anything to reduce the withdrawal symptoms.

  • Will, you know I know that you know tapering is the preferable way to go off psychiatric drugs, and I strongly support you in the efforts you’ve made to communicate that.

    But — I wonder if you titled this piece and slanted it for no other reason than to be provocative.

    I don’t think anyone ever opposed the idea of precipitous withdrawal in the case of unbearable adverse effects, so that’s a straw man argument (or as I prefer, a non-sexist straw dog argument).

    So few people are savvy about tapering — and so many are foolish about coming off — that I can’t believe you think tapering has been over-emphasized.

    (If anything, I personally wish contributors to MIA would at least be consistent in recommending tapering to get off psychiatric drugs, advice that I believe cannot be repeated enough.)

    If the process is called “medication tapering” (which I’ve never heard as a formal term), I say that’s a vast improvement over medicine’s profound cluelessness about getting people off drugs — at least it includes the word “tapering.”

    Now all we need to do is explain to doctors what “tapering” means.

  • I agree VERY STRONGLY with those above who caution against suggesting cold turkey as just another way to go off psychiatric drugs.

    I also agree with Will that in situations where a drug (other than a benzo) is causing unbearable adverse effects, a quick exit may be justified.

    HOWEVER, people need very little in the way of permission to cold-turkey off psychiatric drugs. Despite consistent warnings against it, they do it all the time.

    Although they know psychiatry is lying in everything else, they want to believe withdrawal symptoms are mild and last only a couple of weeks. Or, they think anyone who complains about withdrawal symptoms is, you know, a little funny in the head.

    Given there’s a range of withdrawal reactions, some get away with cold turkey. Others get over withdrawal symptoms within 6 months.

    But others win the bad luck lottery. If you’ve ever experienced withdrawal syndrome, or if you know someone who has, you would never, ever suggest cold turkey is as good a way to go off psychiatric drugs as tapering.

    Let me tell you, the horror of withdrawal symptoms is unimaginable. Our language can not express what they’re like or how bad they can be. Depression? Anxiety? Don’t make me laugh.

    You have no idea until you’ve experienced it.

    And — here’s the deal — other than time, THERE IS NO CURE for severe withdrawal symptoms. If you’re very lucky, reinstatement of the drug will alleviate them, but that doesn’t always work.

    If you don’t know what withdrawal syndrome is like, or don’t believe it exists, I suggest you visit http://tinyurl.com/3o4k3j5 and read a few of the stories.

    I speak as one who has had Paxil withdrawal syndrome for 8 long years, counseled hundreds of people with psychiatric drug withdrawal syndrome, and run a support site for tapering and withdrawal syndrome.

    Believe me, if there was an easy way to go off these drugs, I’d be happy to promote it and close my site. But there’s not, and we have to accept the reality that too-fast withdrawal is yet another danger of these damned drugs.

  • I don’t see why this is needed if withdrawal symptoms are “all in your head” or, as Duncan Double says here http://criticalpsychiatry.blogspot.com/2012/09/what-does-it-mean-to-say-that.html , psychosomatic.

    If this is so, the rate of tapering isn’t an issue. You could simply follow discontinuation (at any rate of tapering, including cold turkey) with a little psychotherapy to disabuse the person of the delusion that he or she is suffering drug damage in the form of withdrawal symptoms.

    We even have bloggers on this site who, because they didn’t experience withdrawal symptoms themselves, don’t think it’s possible that others might suffer from true neurologically generated withdrawal symptoms. It’s “all in their heads,” maybe because they’re whiners.

    So what’s the big deal about psychiatric drug withdrawal?

  • Cymbalta is proving to be very difficult to withdraw from, right up there with other SNRIs Effexor and Pristiq, and SSRIs Paxil, Zoloft, and Luvox.

    Heck, let’s face it — for some people, they’re all horrible to go off. This is affecting millions of people, convincing some they need to stay on the medications for life.

    It’s a huge, hidden public health issue.

  • I agree much seems to be due to peer pressure and cognitive dissonance — whatever you’ve invested in, you’ll defend its value.

    However, there are people who insist they were helped. I was one of these once.

    Will Hall said the action of the drugs and whatever benefit might be perceived is because they’re psychotropics, distracting the nervous system. I have no doubt that people actually feel an effect from the drugs, just as they would from LSD or MDMA.

    In some cases, I think it’s entirely possible the neurological distraction is accurately perceived by the individual as helpful.

  • Will Hall, I was also stunned by what appeared to be a pointed hostile suggestion that you were indoctrinated by Scientology.

    This happens all the time when you criticize the existing psychiatry paradigm. It’s very strange and seems to come from only US psychiatrists. Why?

    Here’s a comment on this I’ve posted elsewhere:

    The position of ideologically motivated groups such as Scientology happens to converge with findings of those who want to improve care in psychiatry. Not all critics of psychiatry are ideologically motivated, they have well-documented reasons for their criticisms. If Scientology is anti-psychiatry, are those people also anti-psychiatry?

    Is there something about psychiatry that is above criticism?

    I’m puzzled by how large Scientology looms in the view of US psychiatrists when they hear criticism of psychiatry. I keep up with news in the mental health industry and I never see Scientology-produced information there.

    I live in a US city [San Francisco] where Scientology maintains several offices, yet I rarely see evidence of Scientology activities, except occasionally there’s a table set up on a street corner where they offer to read your aura or whatever it is they do, claiming to cure all mental ills. (We also have Jehovah’s Witnesses going door-to-door, they abjure psychiatry, but I’ve never seen a psychiatrist rant about them.)

    Scientology has a front group (so Wikipedia tells me), CCHR, producing criticism of psychiatry, but their stuff is easy to avoid on the Web.

    So I’m wondering how actively psychiatrists are harassed by Scientology, or if it’s a convenient straw man to associate with the term “anti-psychiatry,” as a defense against the impact of criticism. Non-US psychiatrists participate in intelligent discussion about failings in their profession without resort to this device.

    Or maybe this fear of Scientology is a proxy for the uncertainty clinicians feel in their own practices. David Healy, a UK psychiatrist often accused of being “anti-psychiatry,” recently addressed the American Psychiatric Association http://healthland.time.com/2012/10/05/psychiatrist-contends-the-field-is-committing-professional-suicide/ with the observation that his profession is “committing professional suicide” via its symbiosis with the pharmaceutical industry.

    Perhaps it’s the subconscious realization that drug-oriented psychiatrists hold a losing hand that drives this preoccupation with Scientology.

  • People need to taper at the rate their systems can handle, Melissa.

    Heather Ashton is a giant in the field of benzo withdrawal, but there are a few flaws in her advice, which was based on experience with addictive drugs.

    One flaw is that she discourages updosing if you run into trouble. If you’re a heroin addict, this could indeed be a problem as it might throw you back into your habit.

    Another is that if you sense the reductions are too much for you, you can hold on the reductions. Let your nervous system settle down and accommodate to the cuts you’ve made already.

    A third is that she recommends antidepressants to counter benzo withdrawal. These bring in their own problems, not the least being they can exacerbate benzo withdrawal anxiety and sleeplessness. They also have their own withdrawal syndrome.

    (Withdrawal syndrome is probably not brain damage but nervous system dysregulation, which can correct. Stay positive! This is important.)

    If you taper very gradually to the tolerance of your nervous system, you don’t have to add a drug to deal with another drug’s adverse effects.

    While some people can go off in a week or month, others take years to go off a benzo or other psych drug, that’s how strong these drugs are. There’s a lot of bad advice about how fast you should taper out there. Each person needs to find her own rate of tapering.

    If you need very, very small reductions, there are a variety of methods to make liquids from benzos. A compounding pharmacy might be able to help with this.

    I agree with all those who say the lack of knowledge about getting people safely off psych drugs is a disgrace to medicine, a public health menace, and a denial of human suffering.

  • Good point. The definition of ACEs case by case cannot take into account every factor affecting the individual. You have a population with X identified factors in common, some but not all develop Y.

    The difference might be genetic (a factor that was not identified) or it could be that the individuals developing Y had other experiences not captured by the survey.

  • Maybe, maybe not, Bob, but there are so many dimensions to personality, behavior, and relationships that I don’t believe you can separate out the genetic component.

    On one level, everything is genetically determined, on another, not much is genetically determined. Even clear evidence of genetically determined diseases has shown the existence of a genetic anomaly is not predictive; many individuals with the same genetic structure do not go on to develop the disease.

    The pursuit of a genetic basis to complex human behaviors is another form of biological reductionism. It may be interesting intellectually but not applicable due to wide human variation.

  • Blood Sugar Levels Linked to Brain Loss
    http://www.medpagetoday.com/Neurology/GeneralNeurology/34588

    Higher blood glucose levels were associated with brain atrophy among healthy individuals in their early 60s, even when levels remained within the official normal range, an Australian study demonstrated….

    Study: Higher normal fasting plasma glucose is associated with hippocampal atrophy: The PATH Study
    http://www.neurology.org/content/79/10/1019.abstract

  • I am having a very hard time with the speculation that the behavior of people who abuse or neglect children is genetically determined in any identifiable fashion.

    Behaviors, language, and attitudes are also passed down from generation to generation in family culture. It’s not necessary to invoke genetics to explain it.

    The logic of behavioral genetics tends to break down when attempting to describe complex human behaviors. I agree with the commenters above who expressed skepticism about distinguishing nature from nurture in much of human emotional life.

  • What a great report! I felt like I was there, Sandy.

    Rather than assume we know what someone means in describing an internal state, it makes a lot of sense to delve more into the person’s feelings and perceptions to understand the person. Language is limited when it comes to feelings; we need to be receptive and find out more what the world looks like to someone else.

    And doesn’t each of us feel better when taken seriously?

    Having the entire team contribute is important, too, as other people might pick up something one doctor alone might overlook or misinterpret. This must be satisfying to the team members, too.

    This is a more human approach in general.

    Was there more to the pre-seminar? Looking forward to your next installment.

  • I still say a lot of that so-called “relapse” after discontinuation of antidepressants is misdiagnosed withdrawal syndrome.

    Those studies finding “relapse” after quitting contained no protocols to distinguish withdrawal symptoms. The statistics on relapse are, therefore, questionable.

    The good news is that “relapse” after discontinuation may not be all that frequent. The bad news is that withdrawal syndrome is more common, severe, and long-lasting than just about anyone wants to admit.

  • That doesn’t seem fair, Sinead. Sandy was only trying to get down to facts regarding Keller’s retirement.

    I tried to find his age but couldn’t. Judging by his college degrees, he’s probably around retirement age. Some university professors retire then, some don’t. Pharmalot speculated that his retirement had something to do with the Study 329 disgrace, but there’s no evidence of that. Maybe he’s gone off to tend his vineyard or something.

  • I believe it’s possible Steve Moffic’s heart is in the right place, but he simply hates hates hates having to discuss what he thinks of as his esoteric field of practice with non-physicians — as though we could not possibly understand it.

    He is having trouble integrating this environment into his schema. He doesn’t understand his audience and keeps on asking for a different one with which he’d be more comfortable — psychiatric patients happy with their treatment.

    That said, I respect him for pursuing this growth experience, although I find his evasions and rationalizations annoying.

  • Nathan, I think another issue is what you call “harm.”

    There are doctors who believe the sexual dysfunction caused by psychiatric drugs is a trivial side effect.

    They will gladly sacrifice a patient’s sex life for some therapeutic benefit that never emerges anyway.

    Medication-induced insomnia? No problem. Here, I’ll write you another prescription (and forget to tell you it’s addictive).

    What you and I might think are substantial risks mean nothing to doctors. Here’s an area where a dialog is very badly needed.

  • Malene, you were taking a very serious risk by going cold turkey. You rolled the dice, and it came up a winner for you. For your sake, I’m glad about that.

    Let me explain again why going cold turkey is not a good idea under any circumstances: You cannot know in advance how the gamble will turn out for you.

    Once you get withdrawal symptoms, your nervous system is damaged. Even people who get over the symptoms in a couple of weeks often say it was the worst experience of their lives.

    If you get severe withdrawal syndrome, it can take you years to recover. You might end up okay, but you’ll never be as good as new again.

    You will be suffering greatly much of the time you are recovering. People sometimes kill themselves, the anguish is so great.

    It’s cold turkey that’s “black and white” — one day you’re taking the drug, the next day, not.

    If you get severe withdrawal symptoms and you know what’s going on, you may realize you need to get back on the drug right away and taper off.

    If you don’t know what’s going on, you believe those symptoms mean you need to be on the drugs for life.

    Or, you may think you’re going to “bull it through” and wait for the symptoms to go away. Months later, you’re still waiting, and getting sicker.

    Now, to me, sliding off the drugs gradually is shades of gray. You can do it the way your body tells you to. You may be able to tolerate a fast taper, or you might find you need to taper very, very slowly. People vary in this.

    One thing they do not vary in, though — if you go cold turkey, you’re gambling with the health of your nervous system.

    Until you experience the damage, you have no idea how awful it can be. Your nervous system runs every function in your body.

    How would you, for instance, like to lose the ability to sleep? That’s for years, not days. (That happened to me. I’ve been recovering from Paxil withdrawal syndrome for 8 years.)

    If you’re interested, you can read hundreds of case histories here http://tinyurl.com/3o4k3j5

    Withdrawal syndrome is not a myth. It is not trivial and does not always last only a few weeks. That is a lie coming from pharmapsychiatry. Any withdrawal symptoms at all represent neurological damage.

    Cautioning people to go off the drugs gradually is not a plot to keep them on the drugs. It’s a way to go off them safely and get away from the clutches of psychiatric treatment.

  • About tapering, starting on page 35 of the 2012 second edition of the Harm Reduction Guide:

    Coming Off: Step by Step
    Reducing Drug Dosage Safely

    The following are general considerations, and no single pattern fits everyone:

    – Usually it is best to go slow and taper gradually. Though some people are able to successfully go off quickly or all at once, withdrawing from psychiatric drugs abruptly can trigger dangerous withdrawal effects, including seizures and psychosis. As a general principle, the longer you were on the drug, the longer you may need to take going off of it. Some people take years to come off successfully.

  • Not to belabor the point, but like any site, MIA has its shares of trolls, who like to disrupt conversations with nonsense, and wankers.

    Since I assume you want to keep an “open door” policy, it would be very helpful to the general population to be able to filter out the nonconstructive posters with an “Ignore” function.

  • Matthew, in the forums, the format commands are not working in the visual editor or in HTML.

    The pagination is also not working — no way to get to the second page of a thread.

    Suggest a support forum where we can let you know about stuff like this.

    Also, the system needs an “Ignore” function so those of us will irreconcilable differences don’t have to be irritated by seeing each other’s posts. Believe me, this is very effective in keeping the peace.

  • This is from “da man in psychiatric ethics”:

    From http://www.behavioral.net/blogs/h-steven-moffic/preventing-epidemic-psychopharmacology-lawsuits April 20, 2012 by H. Steven Moffic, MD

    “You’ve probably by now heard of, or read, Robert Whitaker’s book “Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America” (Broadway Paperbacks, 2010)….

    What I still doubt that we know, however, is how many lawyers have read the book. I can just see some of them salivating over the prospects. I wouldn’t even be surprised if some “ambulance chasers” out there are already finding patients who may have been damaged, or at least a case could be made, by long-term psychiatric medications.

    ….In the meanwhile, our key tool to avoid lawsuits and help our patients to the best of our ability is in informed consent, as tricky as that can be with psychiatric patients.

    So, here’s how I might respond post-Whitaker’s book, and even tell the patient if they don’t ask, all the meanwhile being careful not to scare them away from taking the medication when they really need it. (Of course, I would not say this all in one breath, or without breaks to discuss different points).

    “I would recommend that you try this medication for this problem, but only for as long as necessary. At some point of time, we might want to try you off of it, but when we do so, taper the dose very slowly. Please do not stop the medication all at once on your own, because your body and brain will not have time to readjust. In addition, sometimes there is a so-called placebo effect when first starting medication.

    You may feel better just starting the medication, but it may not be really working yet. Therefore, don’t stop it because you are feeling better for just a few days. We will also explore all other treatments and natural remedies that might help in addition to—or instead of—the medication. In the meanwhile, please try to avoid alcohol and street drugs, for they may limit the beneficial effects of the medications, worsen any side effects, and even cause your illness to become more severe. Is this OK with you? Any questions?”

    Get a signature someplace….”

    Stevie is not appalled at the possibility that, as he says, “the medications may have longer long-term risks to the brain and body that we knew before.” What he is most concerned with is what’s technically called Covering Your *ss.

  • Stevie, the phrasing you used is unequivocal:

    “Psychiatrists know that deficits in the frontal lobes of the brain can cause a condition called Anosognosia, which leaves many prospective patients unable to even realize and accept that they have a mental problem in the first place.”

    Sandy Steingard’s piece expresses doubt that this is something psychiatrists *know* — far from the uber-expert territory you staked out.

  • Nathan, if Stevie’s view of reality is correct, before they enact real change in their profession, progressive psychiatrists want their collective rings to be kissed universally by patients and Scientology to be silenced.

    Which seems more than peculiar to me. Even, maybe, a projection.

  • Stevie —

    That was a straightforward request in order to REFER PATIENTS TO BETTER DOCTORS than they have now, doctors who are giving them bad advice about tapering.

    In response, all you’ve done is play power games. You’ll divulge the information when you get what???

    As a representative of psychiatry, think about how this looks to the rest of the people reading this.

    (Dr. Shipko, by the way, is expert in tapering people off psychiatric medications.)

  • Stevie, I believe my request (repeated often) is very clear.

    Patients are being injured by doctors, including psychiatrists, who do not understand tapering.

    If you know of doctors who do understand tapering, I would like to have their contact information so I can refer people to them.

    Our communication seems to get snarled in strange ways. It appears to me that you take my request as an opportunity to posture about the prerogative of psychiatry and — rather passive-aggressively — suggest you’ll divulge the information if people are a whole lot nicer to you and your colleagues on this site and maybe the rest of the Internet, too.

    The night, the day, the dusk, the dawn — what the heck are you talking about? I’m looking for doctors to help people.

    I believe that you are a nice person, kind to your family, and want to do right. Did you really intend to respond to me like that?

  • You and Ronald Pies both seem to think all of psychiatry’s critics are one big lump of Scientology.

    As I’ve pointed out to Ron Pies, injured patients have very valid complaints. Here’s his very grudging concession at http://www.psychiatrictimes.com/blog/couchincrisis/content/article/10168/1968125

    “….And yet, dismissing all critics of psychiatric treatment as querulous crackpots would be a serious mistake. Some of those who wrote to me were both knowledgeable about psychiatric medications, and sophisticated in their grasp of medical research. Some spoke from painful personal experience with psychiatric medications—whether antidepressants, antipsychotics, or mood stabilizers. They spoke, for example, of becoming agitated or manic while taking antidepressants, and feeling depressed or “doped up” while taking mood stabilizers. They spoke of painful “withdrawal symptoms” lasting many months, after their antidepressant was stopped. They spoke of lethargy, blunted creativity, or impaired cognition while taking antidepressants or mood stabilizers. Perhaps most disheartening, they spoke of how little they felt understood, “listened to,” or respected by their physicians.
    ….
    We need to investigate carefully even the very rare side effects of antidepressants, so that we do not lose the confidence of the general public. We need to avoid even the appearance of conflicts of interest, related to “Big Pharma.” And perhaps most important, we need to listen attentively and respectfully when our patients tell us they are not happy with their treatment.”

    Now here you are on a Web site populated by injured patients, and what you do is repeatedly say you want to hear from somebody else!

  • Stevie, I’m not Duane. You seem to have confused my opinions with his. We commenters are individuals.

    When I say “simpleminded,” I’m talking about readily understandable techniques that few doctors seem to grasp.

    “Agreement on the complexity of tapering”??? What complexity? Who is supposed to be doing the agreeing? Are your friends withholding care from patients because they don’t feel sufficiently appreciated by rest of the world?

    You bragged about knowing umpteen progressive psychiatrists. I asked politely for referrals to help people taper. Now it seems we have to do a little dance around Scientology! Nothing could be more irrelevant to me.

  • Not enough Reply buttons again.

    Yes, we agree that anosognosia is questionable as a psychiatric diagnosis.

    I don’t think we agree that stubbornly holding onto a belief has a physiological correlate in the brain!

    As for that psychopharmacologist, he demeaned me to protect his schema. I adjusted my schema by concluding he was a pompous fool.

  • Okay, I’m still looking for the names and contact information for those more-than-50 progressive psychiatrists who get even the simpleminded basics of tapering people off drugs: Steady, small decreases in doses, no skipping doses.

    I don’t give a hang for whatever interviewing or clinical ritual precedes tapering. Someone’s desire to get off psychiatric medications is a healthy movement towards autonomous decision-making, a keystone of mental health. The doctor should support it.

    My e-mail: survivingads at comcast dot net.

  • Sandy, you said: “I think it may be that our brains differ in ways they make us more or less susceptible to different ideas….there are neuroscientists who are interested in these questions and I think it is a valid area of research.”

    Yes, we are neurologically various, I agree with that. But neurological predisposition to one belief or another? The counter-argument is simple: People do change their minds.

    As for the “neuroscientists” investigating “brain circuits” with fMRI and what have you — very, very dubious, and not only because fMRI produces a lot of noise that can be interpreted (and Photoshopped) to fulfill one’s hypothesis.

    Psychiatrists can’t pass a judgment of anosognosia unless they believe they better understand the state of someone’s mind than the person.

    It takes a great deal of arrogance to make this assumption. Anyone can be subjected to it. A prominent psychpharmacologist told me I was deluded when I said I had severe Paxil withdrawal syndrome. He was wrong.

    So who was deluded? If it was arrogance that caused his “lack of insight” or (as I believe) denial, where does arrogance live in the brain?

    If an individual does not agree with a psychiatric diagnosis, why is that further evidence of brain malfunction?

  • Sandy, you said: “My main point is that I believe it is incorrect to assume that something like “psychological denial” does NOT involve the brain.”

    Yes, of course it involves the brain, or wherever in the body thoughts come from. (We may find out it’s the gut.)

    It just does not seem possible to me that denial leaves physical traces in the brain (or wherever), any more than, say believing in L. Ron Hubbard does. Vice versa, I doubt that pre-existing “brain circuits” make one susceptible to belief in LRH.

    Do you believe there’s a pathological level of denial above the ordinary kind that just about anyone might use? Specifically, so-called anosognosia in schizophrenia and not in any other condition is determined by some physiological structure?

    If so, how do you explain that many people diagnosed as schizophrenic are well aware of their neurological variability?

    As for what seem to be intractable habits of thinking, one cannot overestimate cognitive dissonance and efforts to reconcile it. It seems the human brain is designed for strategies like denial, minimizing, rationalization, etc. — anything but changing one’s beliefs, particularly about oneself!

    For example, anosognosia as described by Errol Morris and yourself, quoting from Kahnemann, easily applies to the thinking of many psychiatrists who deny their patients’ own ability for insight and self-report.

    Correcting the state of “knowing what we don’t know” involves taking in information that might conflict with dearly held beliefs, causing cognitive dissonance.

    Psychiatry seems to excel in its resistance to this, even though it’s very obvious much of the information it holds as true is wrong.

    Surely THIS is a pathological level of denial.

    If you compare an anosognosic psychiatrist’s brain to an obstetrician’s brain, would there be distinctive “brain circuits” related to the anosognosia?

  • Dr. Moffic, I am looking for doctors patients can see who will assist in gradual tapering off psychiatric medications at the rate of least harm to the individual’s nervous system.

    Gradual tapering is the safest way to go off the drugs, but you would be surprised at how few doctors know how to do this, or even grasp the basic concept of “tapering,” or who can recognize withdrawal symptoms if they appear.

    Too many advise their patients to skip doses to taper, a bit of incorrect folk wisdom that’s taken deep root among these supposedly scientifically minded professionals.

    (If you tell a patient to faithfully take medication every day to avoid withdrawal symptoms, why would you advise skipping doses to go off the medication?)

    Anyway, I am looking for tapering-knowledgeable doctors to list here http://tinyurl.com/7cp8l8v for referrals.

    Please contact me at survivingads at comcast dot net if you can recommend any among the 50+ progressive psychiatrists you know.

  • From the Errol Morris article:

    “[David] Dunning wondered whether it was possible to measure one’s self-assessed level of competence against something a little more objective — say, actual competence. Within weeks, he and his graduate student, Justin Kruger, had organized a program of research. Their paper, “Unskilled and Unaware of It: How Difficulties of Recognizing One’s Own Incompetence Lead to Inflated Self-assessments,” was published in 1999.[3]

    Dunning and Kruger argued in their paper, “When people are incompetent in the strategies they adopt to achieve success and satisfaction, they suffer a dual burden: Not only do they reach erroneous conclusions and make unfortunate choices, but their incompetence robs them of the ability to realize it….

    It became known as the Dunning-Kruger Effect — our incompetence masks our ability to recognize our incompetence. But just how prevalent is this effect?…”

  • Sandy, you said “Why do they believe that there are no brain changes underlying the so-called psychological condition of denial?”

    I cannot accept that an opinion or misconception causes a “brain change,” except of course that it involves the same passage of signals from one neuron to another as any other idea. I find the theory that bad ideas cause bad “brain changes” to be alarming.

    Regarding the larger meaning of anosognosia, I highly recommend Errol Morris’s multi-part The Anosognosic’s Dilemma: Something’s Wrong but You’ll Never Know What It Is in the New York Times http://opinionator.blogs.nytimes.com/2010/06/20/the-anosognosics-dilemma-1/

    One can readily see how anosognosia, including the technique of denial, has extensive application in the delusions of contemporary psychiatry.

  • Thanks for this article, Monica.

    It is indeed a pernicious myth that psychiatric drugs act differently in “sick” brains than in normal brains. The fact is that anyone will develop unusual powers of concentration on methamphetamine and methamphetamine analogs such as Ritalin. That’s why college students take speed to prepare for finals.

    The stimulation from these drugs can easily cause “mania,” as anyone who’s spent some time with a compulsively talking (or cleaning) insomniac person on speed knows.

    Someone who is an enthusiast of methamphetamine, prescribed or otherwise, might call its action “brain-boosting” and become very defensive about his or her dependency.

    You cannot underestimate the influence of cognitive dissonance when it comes to drugs that cause physical or psychological dependency, especially when reinforced by the popular idea that one needs such drugs to compensate for a broken brain.

  • Bob, I suggest it’s not ‘“health” [that] has supplanted virtue or righteousness or sanctity as our culture’s prime normative ideal in personal behavior’ but “productivity.”

    Individuals feel they have to be always “on,” ready for action, on the road to success, happy and alert, and, most importantly, invaluable to their employers.

    While “health,” good looks, and youth play into this, the goal is to be an indefatigable machine. Fear, sadness, and boredom slow the machine down and must be banished to return it to top working order.

  • Great article, Corinna. Your energy is impressive.

    What I see at the far right of the chart (“1 Approved Drug”) is marketing. I’m sure everyone in Translational Medicine would agree there’s a place for the community in that!

    I believe one of the reasons universities are excited about participating in Translational Medicine — aside from whatever government grants they can get — is that in exchange for doing the grunt work for pharma, they’re going to get royalties from that one drug that pans out.

    (Translational Medicine was invented by universities in partnership with pharma. Universities needed funding to support their scientific faculties; pharma needed to get other bodies to take the risk for tedious basic research. Together, they lobby governments to cough up the grants for pharma drug development in the guise of pure research uncontaminated by commercial interests. Pharma has every intention of swooping in and buying promising drugs to make the big bucks with less outlay.)

    Since the goal of Translational Medicine is to produce drugs with commercial potential, I’m not seeing the same opening Corinna does for patient interest groups.

    I see more opportunity in the WRAP studies https://www.madinamerica.com/2012/06/wrap-reduces-depression-and-anxiety-improves-recovery/ Patient-Centered Outcomes Research Institute (PCORI) http://www.nejm.org/doi/full/10.1056/NEJMp1207437 and “practice-based evidence” https://www.madinamerica.com/2012/06/plos-medicine-announces-series-on-practice-based-evidence-from-around-the-world/

    The idea of research as a cottage industry is very interesting.

  • The conclusions of this study are probably not valid. Questions:

    – How did they identify subjects at clinical high risk for psychosis? A proposed diagnosis of pre-psychosis was dropped from the DSM-5 amid great uproar about excessive false positives; Patrick McGorry, one of the major proponents of the concept, disavowed it http://www.smh.com.au/national/health/aboutturn-on-treatment-of-the-young-20120219-1th8a.html

    Therefore, selection of the subject population representing clinical high risk of psychosis is questionable.

    – From the abstract: “Basal salivary cortisol secretion was assessed in 33 patients at clinical high risk (CHR) for psychosis (21 medication-free and 12 taking a serotonin reuptake inhibitor and/or atypical antipsychotic), and 13 healthy controls. Among the CHR patients, we also examined associations of basal salivary cortisol with symptoms (positive, negative, mood, stress sensitivity) and clinical outcome.”

    This is a lousy way to test for cortisol levels, which change throughout the day.

    – 12 out of 33 subjects were taking psychiatric medications, which can affect cortisol levels.

  • I agree, Ted. That’s one of the criticisms I have of the UK’s Critical Psychiatry Network — a lot of philosophizing but where are the doctors are offering enlightened treatment to real people?

    Same with a lot of relatively progressive groups looking at psychiatric reform. A lot of talk, no action.

    That’s the problem with the ivory tower and its inhabitants.

    But — Thinking does have to take place before acting, and wouldn’t you want to discuss those currents of thoughts before you have to deal with the results?

  • I agree, bloggers and posters are often attacked here for failure to adhere to an absolutely politically correct point of view or theoretical orthodoxy, the rules of which are known only to the attacker.

    I find this very unpleasant: People who are allies being trashed for a choice of words or prejudices arbitrarily attributed to them.

    It’s a sad reality that people who have been abused sometimes go on the lookout for opportunities to abuse others and go at it enthusiastically when they find the least opening.

    That’s what I perceive as the basis for the excesses that appear in comments on this site, and it weakens the dialog.

  • This is so true, Maria.

    For example, you would expect millions or at least hundreds of thousands of complaints about Effexor XR withdrawal syndrome in the FDA’s database. But according to adverseevents.com, since 1/1/2004 there have been only 1437 such reports.

    That’s unbelievable. Prescriptions for this drug number in the tens of millions, and Effexor XR is famous for its withdrawal difficulties.

    Since only 2008, there have been 665 reports of withdrawal syndrome from Pristiq, Effexor XR’s newly patented sibling.

    Although the rate of AERs is roughly equivalent to that of Effexor XR, I have not been able to get the FDA to look at Pristiq as a problem for withdrawal, and to require Pfizer to provide a greater range in dosages to enable tapering.

    (Right now, Pristiq only comes in 2 dosages, regular 50mg and excessive 100mg, and the tablets should not be split as they’re extended-release coated. But otherwise, someone taking Pristiq has no choice but to quit cold-turkey.)

    (The FDA is so weak you cannot directly access a report from the FDA, you have to get information via third parties such as http://rxisk.org or http://adverseevents.com )

  • Rebecca Riley’s psychiatrist settled a $2.5 million lawsuit (paid from malpractice insurance) for the 4-year-old girl’s death from gross overmedication of so-called “pediatric bipolar disorder.”

    Dr. Kayoko Kifuji’s license was suspended for a couple of years.

    The little girl’s parents were convicted of first- and second-degree murder, respectively, for actually feeding her the drugs.

    http://www.patriotledger.com/news/cops_and_courts/x1097217973/Rebecca-Riley-estate-gets-2-5-million-in-lawsuit-settlement-with-Kifuji

  • Call me cynical, but my guess is the companies do not intend to follow ethicists’ recommendations in practice, but use the advice to help them craft ethical-seeming descriptions of their operations.

  • “We really, really want to believe that suffering isn’t our natural lot, that just doing the right things for good mental hygiene will make for a happy life.”

    Very true. All the philosophers and poets who ever lived are laughing at this folly of modern Western thought.

  • Like so many psychiatric drug apologists, Dr. Koplewicz is very light on logic. It’s almost cruel to whale on him, Dr. Leo.

    Paradoxically, I also believe Kirsch overstates the placebo effect, but not for Dr. Koplewicz’s reasons. Part of the difference Dr. Kirsch attributes to the placebo effect is due to misdiagnosed withdrawal syndrome.

    Dr. Kirsch could not include incidence of withdrawal syndrome in his statistical analysis because NONE of the studies he analyzed differentiated between withdrawal syndrome and relapse. Although incidence ranges from 20%-80%, not a single case of antidepressant withdrawal syndrome was reported in all of those studies. Those cases were counted as relapse, going in the plus column for antidepressant efficacy.

    (In fact, I’ve found only one study of antidepressant efficacy that had a protocol to identify withdrawal syndrome. None of the others, including the STAR*D study, which switched 4,000 people on and off drugs, had such a protocol, instead using only a depression questionnaire.)

    Dr. Kirsch analyzed this plus column, but could not account for withdrawal syndrome because the numbers were absent. Some of the pluses he attributes to placebo were actually withdrawal.

  • More researchers should seek opinions from patients, no matter what strange jargon they use to describe them.

    The more adverse experiences are reported, the more their argument for patient choice is supported. Otherwise, doctors will keep believing everybody just loves the drugs and all they do is good.

    Don’t let your anger stand in the way of informing the medical community that their beliefs are wrong.

    Abstract

    Evidence regarding overestimation of the efficacy of antipsychotics and underestimation of their toxicity, as well as emerging data regarding alternative treatment options, suggests it may be time to introduce patient choice and reconsider whether everyone who meets the criteria for a schizophrenia spectrum diagnosis requires antipsychotics in order to recover.

  • From the Editor’s desk by Peter Tyrer (free full text at http://bjp.rcpsych.org/content/201/2/168.full ) follows up with

    The end of the psychopharmacological revolution:

    “….it is time ‘to reappraise the assumption that antipsychotics must always be the first line of treatment for people with psychosis’. This is not a wild cry from the distant outback, but a considered opinion by influential researchers who help to formulate NICE guidelines. And the reasons for the change in view are not just, as some evidence suggests, a consequence of biased representation of drug treatment in the mass media,3 but an increasing body of evidence that the adverse effects of treatment are, to put it simply, not worth the candle. The combination of extrapyramidal symptoms, dangers of tardive dyskinesia and the neuromalignant syndrome,4 weight gain and the metabolic syndrome, sedation, postural hypotension, and interference in sexual function (but also note the important balancing paper by Reis Marques et al, pp. 131–136, that suggests drugs are not entirely to blame here), would need to be offset by massive symptomatic and social functioning improvement to make the benefit/risk ratio positive. Of course, it often is, at least in the short term, but for many the risks outweigh the benefits….”

  • I don’t condemn the authors’ intention. From the paper:

    “Theoretically, all interventions can be researched to determine their effectiveness. The choice of what is actually investigated is dependent on a number of factors, not least the availability of resources and funding for the proposed research. Thus, the pharmaceutical industry is a key player. Kitcher (2003) stated that elitism in the form of communities of scientists, or scientists in associa- tion with privileged outsiders, such as the funders of research or industry, deciding what to research and how, is no longer an acceptable basis for setting our research agenda. Rather, he advocates for an ‘enlightened democracy’, where the agenda is set based on input from all significant perspectives in society.”

    Heck, yes! Treatments should be studied for real-life effectiveness. Long-term followup is essential. RCTs financed by industry for their purposes are completely inadequate.

    Isn’t real-life effectiveness, or lack of it (actually, the opposite: generation of iatrogenic illness) the subject of Anatomy of an Epidemic?

  • More about Lehrer http://www.psychologytoday.com/blog/addiction-in-society/201208/jonah-lehrer-and-our-thirst-intellectual-reductionism

    Wanted to add — interpreting the psychiatric drug industry also flummoxed New Yorker writer Louis Menand in March 2010. (Bob Whitaker wrote a piece about this here http://www.psychologytoday.com/blog/mad-in-america/201003/fact-checking-the-new-yorker) Ordinarily, Menand is an excellent writer on cultural subjects.

  • When I read Lehrer’s piece in the New Yorker, my first thought was that the earlier studies were pile-on-the-bandwagon junk and the later studies were more objective, and Lehrer had completely missed this potential interpretation, which showed a certain naivete about the drug biz. Or maybe it shows how cynical I am.

  • Yes, the author’s main concern is getting drug development back on track, conducted by academics with government funding instead of pharma employees.

    Then the drug companies can swoop in and invest in anything that looks promising without wasting money on research that dead ends.

    Pharma loves this idea. They get the profits, taxpayers assume the financial risks. It’s an advance for corporate interests in the name of science.

  • An extremely important resource for coming off medications safely.

    I’m very glad to see the guidelines for reduction have been revised to “10% or less reduction of your original dose every 2-3 weeks or longer.”

    I would add — perhaps in the next edition — “make a smaller reduction if you get serious withdrawal symptoms.

    Withdrawal symptoms are nature’s way of telling you to slow down! While some may be transient, they’re signalling that your nervous system is in distress. Try to reduce in a way to minimize stress on your nervous system — it’s the only one you’ll ever have.”

  • Oh yeah, aging is going to be a bonanza for psychiatric pharma. They’re ginning up the Alzheimer’s drug research right now.

    Maybe psychiatric medication will serve a social Darwinist purpose, a way for society to shorten the lives of those darn baby boomers, relieving some of the burden of expense to provide medical care for them.

  • Anonymous, you might read some of the research about this, particularly by David Healy, who’s been campaigning about the antidepressant-suicide connection for 12 years, see http://www.guardian.co.uk/education/2001/may/07/medicalscience.highereducation.

    1boringoldman.com has exhaustively critiqued Gibbons’s work.

    Of course, your beliefs about personal responsibility, as Ayn Rand might call it, may be impervious to any incoming information.

    Insistently, you have presented such beliefs to an audience among whom are those who have lost loved ones after watching them deteriorate and kill themselves under the influence of antidepressants.

    If denial from the medical establishment has not caused them pain enough, explaining the justness of their cause — exposing the dangers of psychiatric drugs — to someone holding opinions like yours might be simply too much to bear.

    I urge those people to ignore your further posts on this site, as I am going to.

  • Robert Gibbons shares your belief, Anonymous, and has done everything he can to disprove a causal link between antidepressants and suicide. His latest efforts involve dishonest statistics, so I guess he hasn’t had much luck finding real evidence to support his intuition.

    You are fortunate if you have not had such severe adverse effects from psychiatric drugs that you have not considered suicide. The physical, psychological, and cognitive effects can be so awful that suicide can seem a reasonable solution to torment for which there seems no medical cure.

    Akathisia, a relentless inner agitation that allows no sleep or rest, is an example of such an adverse effect. It exists only as an adverse effect of medication. People suffering it often think they have literally lost their minds.

    Having no apparent recourse, out of free will, someone may reasonably choose to suicide because of the effect of psychiatric drugs. People experience intense sensations they would not have felt without the drugs. The drugs induce such anguish, therefore the drugs are the trigger for suicide.

    I’ve looked into the abyss myself, and for no reason but unrelenting torment from an antidepressant. If it weren’t for a very lucky meeting with a doctor who identified my adverse reaction, I wouldn’t be here today, I would have carried out my plan.

    I can understand entirely the link between antidepressants and suicide which, if anything, is under-reported.

  • I hope that Keris Myrick’s psychiatrist, Timothy Pylko, learned from her that his initial assumption that her illness had to be bludgeoned into submission with daily long-term psychiatric medications is incorrect, and has applied this lesson to other patients.

    I also hope he’s told his colleagues about these important findings: That a treatment regimen must take into account the whole person; that medication may be used as only a short-term, temporary crutch; that there is no one-size-fits-all dosage or dosage regimen; and that chronic medication can interfere with the individual’s functioning and quality of life.

  • philroy, Anonymous etc. is of the opinion the only adverse effects that can be attributed to neurologically active drugs are some physical symptoms, such as tardive dyskinesia.

    According to Anonymous etc., neurologically active drugs cannot overwhelm cognition, emotions, decision-making, or behavior, despite massive evidence to the contrary.

    Anonymous etc. believes this position is a necessary corrective to statements linking antidepressants and suicidality or violent behavior.

  • I think it’s David Nutt, of the European College of Neuropsychopharmacology, who wants different classifications for antidepressants, antipsychotics, etc. because they sound so unpleasant and the drugs are crossing categories.

    Pharma is enthusiastic about this, too. Rebranding, always so helpful to expand sales.

  • I’m glad somebody brought up the possibility those medications might cause suicide.

    The combination of Effexor and trazodone or Effexor, Pristiq, and trazodone can lead to serotonin syndrome or other serious adverse reactions.

    Adding Pristiq to Effexor would have been extremely stupid but not beyond many doctors. If that or an increase in Effexor dosage was recent, the change in medication might have adversely affected her to the point of suicide.

    Trazodone alone can have severe adverse effects. It has an active metabolite, mCPP, which is used to induce anxiety for study in the laboratory.

    Effexor/Pristiq and trazodone’s mCPP are metabolized via the same liver enzyme (P450 CYP 2d6). Taking them together could cause a traffic jam in the liver leading to elevated levels of venlafaxine (and its metabolites) or mCPP or both in the blood stream.

    Any or all of these adverse reactions could be so uncomfortable as to cause someone to think of suicide as a plausible solution.

    If, as so often happens, the person had been to the doctor for help with the adverse symptoms and been told they’re signs of worsening mental illness, suicide can seem to be an inevitability.

    I certainly hope a doctor or doctors get scrutinized in the course of this investigation.

  • Ablow is supposing Holmes will enlist forensic psychiatrists in her suit against Cruise, but it’s only his fantasy now.

    It would be darned amusing to see psychiatry vs Scientology in court, though, the clash of two massive edifices of manure.

    Ablow writes “It is no surprise, therefore, that L. Ron Hubbard, who founded Scientology, offered his insights to the American Psychiatric Association. And it is no surprise, given that organization’s own rigidity, that he was rebuffed. The ill-will that ensued has only intensified over the decades since.”

    Wonder if that’s true? Undermines Scientology’s anti-psychiatry as purely humanitarian, implying it’s a grudge thing. Entirely believable of Scientology.

  • Withdrawing too quickly could cause nervous system damage, that’s effectively what withdrawal symptoms or “rebound psychosis” are.

    The rate of taper is what’s up to the individual. The nervous system needs stability. Going off the drug as slowly as the individual requires is the best way to minimize risk of destabilizing the nervous system.

    The stories you might hear of people who quit cold turkey and had no problems are stories of people who were very lucky.

    Don’t be a daredevil and go cold turkey no matter how much you hate your medication, you could be living with withdrawal syndrome for years.

  • The belief that psychiatrists have in the drugs they prescribe is a proxy for the belief that they themselves perform miracles and are therefore important to medicine.

    The drugs are talismans for power and prestige. The belief is wholly irrational and self-deluding.

  • Oh, of course psychiatrists believed their own propaganda.

    That article by Ron Pies is nothing but an effort to save face. He’s trying to say psychiatry wasn’t so stupid as to be hoodwinked (when it was) and the “chemical imbalance” lies told to patients were to make them feel better, not because the doctors were clueless (when they were).

    Otherwise, it would have been a confession that psychiatrists are not the intellectual giants they claim to be, fit to stand astride both psychiatry and neurology and call themselves “neuroscientists.”

    Psychiatry, as exemplified by Dr. Pies, is squirming to get out of the mess it’s made with sloppy science and careless clinical practice. Dr. Pies excels as sophistry in this regard.

    Katherine Sharpe’s book appears to be soft on science and big on sensationalistic human interest in a topic that is actually of utmost importance: An entire generation being injured by misdiagnosis and unnecessary psychiatric medication — except she doesn’t address the misdiagnosis and lack of necessity.

  • http://www.minyanville.com/sectors/biotech-pharma/articles/glaxosmithkline-dr-drew-drew-pinsky-loveline/7/3/2012/id/42166

    “Glaxo indirectly paid Pinsky, also known as Dr. Drew, $275,000 in two payments in 1999 when he was hosting Loveline on radio and on MTV, US prosecutors charge. (The MTV show is no longer on the air.) Justice Department prosecutors say that Glaxo was promoting depression drug Wellbutrin for weight loss, sexual dysfunction, drug addiction, and attention deficit hyperactivity even though it wasn’t approved for those uses.

    In June 1999, Pinsky went on a national radio program and pumped Wellbutrin for its libido-enhancing effects, the US charges. [PDF page 22] Pinsky said “switching to or adding Wellbutrin is recommended for people experiencing a loss of libido,” the feds say.

    What’s more, Pinsky said on the show that the active drug in Wellbutrin “could explain a woman suddenly having 60 orgasms in one night,” according to the US complaint.”

  • Looks bad for Dr. Drew cbsnews.com http://www.cbsnews.com/8301-504763_162-57466472-10391704/dr-drew-pinsky-responds-to-allegations-he-received-glaxosmithkline-payments/

    “The document states that Pinksy allegedly received two payments in March 2009 and April 2009 from GlaxoSmithKline totaling $275,000 to promote Wellbutrin SR. The Wall Street Journal reported in June 1999, he made statements on “Loveline,” a television and radio show he co-hosted, saying that he prescribed Wellbutrin to depressed patients because it “may enhance or at least not suppress sexual arousal” as much as other antidepressants are known to do. Pinsky was also reported to have made comments on other media, including another national radio program called “David Essel – Alive!,” Forbes added. In both instances, he did not disclose that he was paid by the company to do so, and he promote uses of Wellbutrin that had not been approved by the Food and Drug Administration.”

  • “However, this obscures differences in symptom spectra, relating mainly to the distress caused by each individual symptom. For example, perceptual hypersensitivities bedevil the patient attempting to withdraw from BZDs, and these may be protracted”

    This is also true in SSRI withdrawal, and in withdrawal from other psychiatric drugs.

    Withdrawal symptoms represent nervous system damage, specifically autonomic dysregulation.

    Given how pervasive the autonomic nervous system is, this takes various forms among individuals, which explains the wide range of symptoms from head (e.g. “brain zaps” or dizziness) to foot (e.g. foot and leg cramps, restless leg syndrome).

    “Finally, we should not lose sight of another fundamental difference. Despite withdrawal reactions, most SSRIs have a favourable risk/benefit ratio.”

    I contest this. SSRIs may have a favourable risk/benefit ratio only because of medicine’s staunch refusal to recognize adverse effects, such as prolonged antidepressant withdrawal syndrome.

    “By and large, BZDs do not meet this criterion and should be avoided wherever possible.”

    I agree with the caveat about SSRIs stated above.

  • Withdrawal symptoms from any psychiatric drug represent nervous system damage, specifically autonomic dysregulation.

    Given how pervasive the autonomic nervous system is, this can take various forms in people, which explains the wide range of symptoms from head (e.g. “brain zaps” or dizziness) to foot (e.g. foot and leg cramps, restless leg syndrome).

    Wonder how long it will take medicine to openly acknowledge this.

  • Calling a 32-year-old woman a “teenage runaway hooker” is like calling Barack Obama a “teenage basketball player.”

    At the time Ashley Dupre met Eliot Spitzer, she was 22. There is no evidence Spitzer hired teenage prostitutes.

    While runaway teenagers may become prostitutes, and Spitzer hired prostitutes, associating Spitzer with teenage runaway prostitutes is a “straw man” argument used, as is typical for that type of argument, to inflame the accusation.

  • If I might suggest, try reductions of 25mg every 2 weeks. The idea is to have little or no withdrawal reaction.

    The very gradual reduction may enable your nervous system to adapt to the decreases as you make them.

    If you get withdrawal symptoms, stop for a while until you stabilize, then slow down the tapering and make smaller decrements.

    Hopefully, when you do this, you will have no withdrawal after you are entirely off the med because your nervous system has already made the adaptation.

    Very gradual tapering is far safer than counting on supplements to be helpful, because often they don’t do much.

  • Escitalopram — Lexapro or Cipralex — at a dose of 30mg is also implicated in cardiac risk.

    Milligram for milligram, escitalopram is several times stronger than citalopram yet, according to the article, the maximum dose in the UK, 20mg, will remain unchanged. Escitalopram 20mg is roughly equivalent to the 60mg citalopram found to raise cardiac risk.

  • If you have insight to the point that you disagree with the doctor or, heaven forbid, become angered by the treatment you are getting, you are guaranteed to get an escalated psychiatric diagnosis, perhaps something with “delusions” or “agitation.”

  • I agree, I think Breggin’s use of the term “spellbinding” regarding psychiatric drug use is hyperbole that erodes credibility.

    There’s a much simpler and more plausible explanation than “spellbinding”: Cognitive dissonance.

    People believe the drugs are helping even though all they might experience is side effects because they are invested in the belief. This investment might be social (conformity to expectations of society, doctors, family, etc.), financial (going from doctor to doctor in search of a “cure”), or because they have sacrificed a chunk of their lives pursuing a chemical correction.

    It’s the same reason people have trouble letting go of bad investments — “I’ve put so much into it, I can’t give up on it now.”

  • I found CBT very unappealing. It was too dogmatic for my taste. You are forbidden to have certain thoughts or describe them using certain words; the therapist is the judge.

    It reminded me of Neuro-linguistic programming (NLP). It was irritating.

    Of course, my therapist was a jerk. In the right hands and for the right situations, I think CBT could be quite effective for certain people.

  • I believe there is just one study, out of psychiatry, that found meds plus therapy to be superior to either alone. (Perhaps someone has the citation to hand.)

    Otherwise, in the medical literature, the strategy of adding meds to therapy is a “just in case they work” argument, completely leaving aside the possibility of adverse effects.

    In other words, the meds are considered a safety net.

  • “Drugs of sin” are what I call the drugs that somewhat arbitrarily are the focus of law-enforcement efforts, incur jail time, and from which sick “addicts” are “rehabilitated” for “addiction.”

    “Drugs of psychiatry” are what I call drugs that somewhat arbitrarily are the focus of medical proselytizing, incur psychiatric diagnoses, and from which sick “patients” have to suffer through withdrawal on their own because of “physical dependency.”

    “Prescription drug abuse” is a euphemism for when “drugs of psychiatry” are used by people without asking permission from doctors.

    “Maintenance” is a euphemism for when “drugs of psychiatry” are used by people with permission from doctors, getting their (or their child’s) drug prescription filled for years without your doctor actually showing any interest in its usage.

    SAMHSA is a government agency charged with discouraging addiction to “drugs of sin” and encouraging dependency on “drugs of psychiatry.” Sometimes they’re the same drugs, such as the amphetamine analogs, benzos, and painkillers. (I hear there’s an underground market in Seroquel, too.)

  • I am also quite angry about the way psychiatric drugs and psychiatric and how its huge edifice of self-serving lies ruined my life, too, Nancy.

    I once had a good professional career. For the last few years, I’ve been all but house-bound.

    My heart breaks for every person injured by psychiatry. I agree its practices very frequently are crimes against humanity.

    I join you in your outrage and protest and encourage everyone who has been injured by psychiatry to speak out, loudly, and often.

    Thank you for raising your voice about this!

  • Back to the article — whatever happened to academic integrity? When did intellectual dishonesty take over? How can any academic allow someone else to write his or her paper?

    What the heck is going on? Is this all part of the trend towards university-business partnerships? If so, the university is selling its soul. I hope it gets a good deal.

  • The researchers’ original sin is supposing the mice develop what even in articulate humans is difficult to define as “depression.”

    These giant fanciful leaps in reading mice minds are the foundation of biopsychiatry research.

    This is why, when the resulting drugs are applied to humans, they only kinda sorta work, if you squint and look at the data the right way.

  • Nancy, it’s good to hear you are healing from this terrible ordeal.

    What we see over and over in virtual communities that offer peer support for psychiatric drug withdrawal is that too-fast withdrawal from any of the drugs causes hypersensitivities of various types.

    For some people, it hits the gut and immune system. Many become hypersensitive to light (although yours seems extreme), or sound, or even smells.

    Relentless sleeplessness and that abnormal alerting you described is very common.

    What psychiatric drug withdrawal has in common across all drugs is that it causes nervous system dysregulation, producing a wide range of mysterious, debilitating symptoms that no medical test can detect.

    The autonomic dysregulation allows the alerting system to rule the body. It wants to stay on high alert 24/7. If you take medications to calm it down, it will react paradoxically.

    There are only a few doctors in the world who recognize the severity and persistence of severe psychiatric drug withdrawal syndromes; David Healy in the UK is one of them.

    Withdrawal-induced hypersensitivities vary from person to person. We have seen bad reactions to each of the supplements in The Road Back program and other supplement programs.

    What we tell people on SurvivingAntidepressants.org, which includes people withdrawing from every type of psychiatric drug, is to take supplements one at a time, try a fraction of a dose first to see how it affects you, and reduce dosage or stop taking it if you get a bad reaction.

    We do not recommend mixed supplements at all; if you get a bad reaction, you won’t know which ingredient did you in. (We do not recommend any supplement programs; to some degree they are all overhyped and overpriced.)

    Overall, people with withdrawal symptoms seem to do best with fish oil (and vitamin E to help it work), magnesium (calming and relaxing, melatonin (to trigger sleep), and reducing stimulation (such as turning off lights at nightfall). (Even so, some people are sensitive to fish oil and magnesium; their nervous systems need to stabilize a while before they can take them.)

    The B vitamins are risky. For some, vitamin B12 is very helpful, others have a strong adverse reaction. Generally, vitamin B6 tends to be too activating.

    Restricted non-irritating diets (gluten-free, SCD, paleo) seem to help some people quite a lot.

    Supplements might soften symptoms but time is the great healer. Learning patience and how to manage symptoms with techniques such as meditation are challenges for us all.

    There are ongoing discussions about symptoms and what helps at http://tinyurl.com/3hq949z , and tapering tips at http://tinyurl.com/42ewlrl

    We are also collecting case histories of psychiatric drug withdrawal syndrome in the Introductions section http://tinyurl.com/3o4k3j5

    I hope this helps answer some of your questions about what happened to you, although the damage has, most regrettably, been done.

    Good healing to you.

  • It takes a fairly radical frame of mind to accept a reality where ALL the so-called “evidence” is questionable.

    We’re looking at a giant edifice of studies and commentary on studies and surveys of studies that has no more medical validity than religious dogma.

    The amount of dishonesty, stupidity, and willful blindness in psychiatry is something usually described only in the most elaborate conspiracy theories. It’s incredible that a branch of medicine (or pseudo-medicine) could go so completely wrong.

    The numbers of billions of dollars accrued by all this corruption is also incredible — psychiatric drug purchases amounted to $40 billion in 2011 alone, according to Robert Whitaker.

    For the last decade, psychiatric drugs have provided a huge chunk of the income of major pharmaceutical manufacturers. For example, in 2009, Zyprexa represented 23 percent of Lilly’s total sales http://topics.nytimes.com/top/news/business/companies/lilly_eli_and_company/index.html

    In psychiatryland, truth is stranger than fiction!

  • Brain atrophy in depression??? Excuse me?? When did this become a fact?

    Note the abstract starts with a questionable premise: “Decreased neuronal dendrite branching and plasticity of the hippocampus, a limbic structure implicated in mood disorders, is THOUGHT to contribute to the symptoms of depression.”

    (Emphasis mine.)

    As usual, starting with a false premise leads to conclusions that might hold in an alternate reality.

  • As I interpret it, the “chemical imbalance” theory is, was, and always will be a manipulation to get the patient to agree to take drugs.

    Same with “brain disease” or “diseased brain circuits.”

    Many doctors have not troubled to deconstruct what any of this jargon means. They merely say it’s too complicated to explain fully, trusting that some rumor of brain scans or serum components explains it all.

    A very wise person once told me if something is too complicated to explain, it doesn’t exist.

  • Your article is an excellent summary, Dr. Levine.

    About STAR*D — About 4,000 people were switched on and off drugs in the STAR*D study, yet the data contain not a single case of antidepressant withdrawal syndrome.

    Given the prevalence of withdrawal syndrome (30%-80%), this is not a credible result. A washout period of a couple of weeks between antidepressant trials is simply not enough time for withdrawal symptoms to vanish completely.

    The multicenter STAR*D study (inconsistent criteria, study supervision, and scoring) only used an instrument to capture symptoms of depression as a scoring device; it contained no questions pertaining to withdrawal symptoms. Withdrawal syndrome was most likely counted as “relapse,” sending the subject on to the next leg of the study.

    If data about withdrawal symptoms had been captured, STAR*D’s questionable statistics showing antidepressant efficacy would be even more questionable. Efficacy probably would be firmly in the negative column — more harm than good.

  • I believe we’re in agreement, Bob. It depends on what you call “psychiatry.”

    Is there a gullible sheeplike rank and file thoughtlessly following the DSM-5 committee and the profession’s great thought leaders such as Schatzberg, Nemeroff, Rush, Keller, Biederman, and Insel? (See http://1boringoldman.com/index.php/2012/06/24/further-instruction/ )

    Or are these thought leaders and the DSM-5 committee representative of the APA membership, with the DSM-5 folks devising an illogical, inaccurate, destructive diagnostic system at the behest of the masses?

    Either way, psychiatry’s leadership consciously or unconsciously puts a lot of work into justifying lazy doctoring that’s mostly throwing prescriptions at people and ignoring the consequences.

  • “Gavin Barwell, the Conservative who sponsored the bill, said he expects that in a few years it will seem amazing there were laws discriminating against the mentally ill.”

    Doesn’t this article demonstrate there is no distinction between the “mentally ill” and everybody else?

    If someone is a member of Parliament, he or she is not incapacitated by whatever mental condition claimed. Is that really “mental illness,” whatever *that* is? Or is it evidence that everyone has traits that may hamper success?

    It seems to me this article illustrates how far medicalization of everyday life has progressed.

  • Given that I’m an American, I agree with Dr. Datta’s suggestion that there’s something very wrong with American life (as an example of what’s wrong with many post-industrial states).

    People should not have to take drugs to tolerate their jobs, yet that’s what people do when they’re stuck in tedious, pressured corporate work that keeps them sedentary and isolated all day.

    People should not be taking drugs to deal with unhappy marital relationships, they should be dealing with their relationships.

    People should not be taking drugs to bear the privations of poverty, yet they do.

    I agree with Dr. Datta the existence of these anesthetizing agents, much of which is prescribed by doctors, keeps the general public from looking at what’s wrong with society, the blame for failure being shifted to the individual.

    However, I do not agree that all the above has absolved the individual physician of his or her responsibility to at the very least do no harm to patients. That is a societal contract that has not yet been dissolved.

  • (Where the *heck* is the reply button to Dr. Datta’s post?)

    Dr. Datta says: “why did we allow psychiatry to have so large a role in repression and managing our subjectivity in the first place? ….American society maintains its need to displace the source of distress in individuals, and not look too closely at the structure of society itself.”

    This is the argument that places blame on a purported neoliberal movement, upon which psychiatrist-blogger Dr. Tad holds forth most amusingly here http://left-flank.org/category/psychiatry/ and elsewhere.

    (I repeat, it’s not only America where these forces are in sway!)

    Dr. Datta, getting away from the hypothetical forces of history, which may be discussed for decades without conclusion — despite patients abandoning responsibility for their lives and asking to be medicated, despite pharma propaganda, corrupt psychiatry thought leaders, subverted research, and the pressures of managed care, how can individual psychiatrists not perceive evidence of obvious adverse effects right in front of their faces?

    This is a burning question among injured patients, who make up part of your readership here.

    Where I would take issue with your perspective is that it, like the neoliberal movement, relieves the individual of responsibility — in this case, individual psychiatrists. In the one-to-one relationship with the patient, the psychiatrist is suffering some kind of cognitive block that negates perception of iatrogenic harm.

    (And who told the DSM-5 committee to add and blur diagnoses? It wasn’t clamor from the general public that made them do it.)

    While it may be true that psychiatrists could disappear from the face of the earth tomorrow and other professions would quickly take over providing inept psychiatric treatment, while is it these specialists practice the way they do?

  • In fact, I place my hopes for correction of psychiatric overmedication and the epidemic of iatrogenic conditions caused by it on public health studies.

    While they’re not devoid of politics (with representation of the long arm of entrenched interests), public health studies at least have the explicit objective of improving public health and protecting the patient, as opposed to that of the medical-industrial complex now running mental health treatment.

  • Sinead, I think the commercialization of mental health succeeded beyond pharma’s wildest dreams and not even their marketing people imagined the largest companies would be reaping the majority of their income from psychiatric medications.

    I have a suspicion Dr. Datta is not entirely ignorant of the history of this cultural development and he will be sharing his perspective in installments here.

    As near as I can tell from what he’s posted so far, his perspective is critical of this cultural trend.

  • “perhaps as a spy is managed in a Le Carre novel” — yes, recruited, indoctrinated (or manipulated), and sent on missions.

    I used to work for a biotech (no psychiatric drugs) and got to see how they trained sales reps to recruit KOLs. They targeted likely doctors and set out to seduce them just as deliberately as any spymaster looked to recruit agents.

    It sure humbles the profession, to see intellectually arrogant physicians fall for flattery, favors, and barely disguised bribery, and so readily go off to do pharma’s bidding.

  • Dr. Datta is a skeptic. He wrote:

    “What no one quite imagined was that the mental health industry would become unstoppable, with seemingly no end to the situations that could make us mentally ill, no person too well to benefit from therapy. Eventually the mental health industry became a poisoned chalice, rather than deflecting from society’s failings, it added to them.”

    Personally, I can’t find any fault with those statements.

  • I guess the generalizations about psychiatrists are difficult for a psychiatrist to hear. Are they a personal attack or “present company excluded”?

    Unfortunately, the truth is a good psychiatrist is very, very hard to find. The run-of-the-mill psychiatrist is, perhaps unintentionally, careless and poorly informed. Yet every single one thinks he or she is outstanding and patients are complaining about somebody else, maybe those darn GPs or the bad apples.

    No, sorry, Hey-Hey, we’re complaining about the general state of psychiatry! All that corruption and bad information has paid off in degrading the profession, as you very well know. How could it not?

    To regain respect, psychiatry needs to clean its own house.

    Best wishes in your retirement!

  • If you don’t care to report an effect as adverse, don’t report it.

    If you’re so concerned that a patient-authored adverse event report might be false, figure out a way to improve upon the reporting process.

    Your insistence that psychiatric drugs do not have adverse effects other than observable physical phenomena has only nuisance value.

  • 1boringoldman.com recently had a series of posts, the most recent here http://1boringoldman.com/index.php/2012/06/17/a-minority-report-ii/ , where he pondered the conflation of melancholia with “depression” and any number of “down” conditions.

    He traces the history of the “depression” diagnosis in various DSM editions.

    It’s led to an enormous amount of diagnosis creep, begging the question: Why hasn’t all this confusion been clarified in the proposed DSM-5? (In fact, the DSM-5 “depression” diagnosis failed in field trials.)

    It seems to me, psychiatry allows this nonsense to stand because it doesn’t matter what the diagnosis is, the treatment is going to be an arbitrary succession of drugs anyway.

  • There are people who have difficulty tapering off Wellbutrin, but that’s definitely much more rare than withdrawal problems from any other psychiatric drug.

    Personally, I had an adverse reaction (blood pressure spikes) while I was taking Wellbutrin and, on my own, went off it very quickly. After I stopped, I found it had elevated my blood pressure 30-40 points. I had no withdrawal symptoms, only a sense of relief.

    (It had been prescribed by a psychiatrist, and I had been seeing psychiatrists, but no psychiatrist ever took my blood pressure or seemed the least bit interested in it.)

  • You should become a devoted reader of 1boringoldman.com, Sinead. He’s doing the dirty work re-analyzing these corrupt studies.

    I believe he’s used the terms “willful deceit” and “criminal” and maybe “psychopathic” in connection with some of this research.

  • From Dr. Datta’s blog article, I gather he believes there are social or cultural reasons why people believe they have psychiatric disorders and seek medical help.

    I wouldn’t extrapolate from this any ulterior motives or bad doctoring. He seems to be questioning the reigning paradigm.

  • Mass General is the site of a research-for-hire paper mill run by Mauricio Fava. His customers are pharmaceutical companies.

    If you get worked up over Mass General’s paper mill, you will wear yourself out, Sinead.

    We can expect more garbage research to appear in a major psychiatric journal in a year or two, but that would be nothing new.

    Unless Dr. Datta is involved in the study, I don’t think he can answer for it.

  • It means, Sinead, that corporate forces are more and more turning people into fodder for profits (consumers) and deadening corporate jobs (employees). Unless the people themselves resist this, this is the trend in developed and developing societies that embrace the religion of the free market.

  • Steve Moffic, leaving aside psychiatrists’ hurt pride and feelings when they are criticized, when is the profession going to stand up en masse for patient safety?

    That’s what psychiatry’s critics are talking about. And you don’t need an MD to read and critique scientific studies. Sometimes it seems you are saying only psychiatrists can criticize psychiatry (a risky career path), non-doctors have no right to even an informed opinion.

    I find it interesting that you are getting your information about Cymbalta dangers from http://www.worstpills.org rather than the American Journal of Psychiatry or even Psychiatric Times. How many doctors apprise themselves of risks via http://www.worstpills.org?

    (By the way, Cymbalta comes in 20mg capsules — so what? Patients sensitive to dosage reductions still have to open the capsules and count out the pellets.)

  • Steve Moffic, I would be happy to post the names, addresses, and phone numbers of doctors who grasp the importance of tapering at a rate that is tolerable for each individual.

    I have lots of complaints from patients that they are getting bad advice from psychiatrists as well as GPs about tapering. Patients are being badly injured, see http://tinyurl.com/3o4k3j5

    To serve the approximately 36 million on psychiatric drugs in the US, I’d like to list at least one doctor knowledgeable about tapering for every metropolitan area.

    So far, I am finding it very difficult to find these doctors. If you have such a list, please send it to me at survivingads at comcast dot net. (If you offer this service yourself, please send your practice contact information.)

    I will post it at http://tinyurl.com/7cp8l8v and close up my peer support site for withdrawal immediately.

  • Vivek Datta said: “the withdrawal syndrome is far worse than difficulties that made them seek antidepressants in the first place…”

    So true, and so rarely heard from a doctor! Please write me at survivingads at comcast dot net regarding tapering and withdrawal syndrome.

  • Steve said: “I agree with your basic premise: modern life is inherently stressful, and a depressed reaction to it is very understandable. When we reach a point where over half of the members of a group manifest a certain response, it’s time to stop defining it as abnormal and to start looking at the structures that they are reacting to.”

    Yes, exactly. As long as each individual believes he or she has failed and needs chemical correction, issues in the larger culture will become more and more onerous, breaking more and more spirits.

  • 1boringoldman.com has published a series of articles on the sleight-of-hand hiding the dangers of antidepressant-induced suicidality in youth, the most recent is http://1boringoldman.com/index.php/2012/04/16/an-anatomy-of-a-deceit-6-anticipated-and-forestalled/

    He points out all kinds of ways Gibbons et al have been playing with statistics, the shoddiness of the journal articles, and the lack of quality control at Archives of General Psychiatry.

  • In the US, patients may visit psychiatrists without going through a primary care doctor first.

    From what I’ve seen from these cases http://tinyurl.com/3o4k3j5, psychiatrists are nearly as likely as GPs to overprescribe and are scarcely better at recognizing adverse effects or knowing how to taper off safely.

    I agree with Sinead and yobluemama, psychiatrists are opinion leaders when it comes to psychiatric drugs. If the psychiatric profession was vocal in emphasizing the need for conservative prescribing and making patient safety a priority, other doctors would sure heed what they say.

    At the very least, psychiatry long ago should have taken a strong stand against the widespread advertising of psychiatric drugs in the US. (Too late now, pharma’s cut the ad budgets as psychiatric drugs have gone off-patent.)

    Instead, psychiatry has been unified in hyping the effectiveness of medication and obscuring the risks. Just the potential increase in diabetes alone should be enough to cut the frequency of prescribing! How often do we hear any psychiatrists warning about this?

    And the garbage psychiatry’s main journals still publish as “research” — really, psychiatrists should be up in arms about that misinformation, which readily filters down to general practitioners.

  • David Healy answers questions on his blog at davidhealy.org, where this article was originally published.

    You might pick up his book Pharmageddon for citations.

    Gathering credible, detailed adverse events reports on RxISK.org would further the cause of patient safety tremendously.

  • Much as I admire Dr. Phelps, he does give credence to the possibility these patients might have had some underlying subtle “bipolarity.”

    From my observation of hundreds of cases of withdrawal syndrome, I do not believe antidepressants “unmask” bipolar disorder. The entire body of scientific literature positing this is in error, mistaking adverse effects of antidepressants — anxiety, agitation, sleep disruption, hypomania, mania, etc. — as symptoms of bipolar disorder.

    The situation is complicated in that for some people who suffer adverse effects from antidepressants, either in taking them or discontinuing them, the nervous system disruption does not stop after they quit the drugs. Recovery from adverse effects can take years, with symptoms coming in waves that very gradually abate. An inattentive doctor might mistake this for cycling.

    However, Dr. Phelps is very open-minded and concerned about his patients. He’s independently concluded gradual, individualized tapering is best. I have confidence he will continue to learn more about withdrawal symptoms and that they can be distinguished from “bipolarity.”

  • Dr. Datta, thank you for your contribution.

    I agree, the very word “depression” has almost lost its meaning. Now whenever people suffer disappointment, frustration, sadness, loneliness, or existential angst, they might say they are “depressed.”

    Patients’ self-diagnosis is embraced eagerly by doctors as long as the patients are claiming a psychiatric condition at which a prescription can be thrown.

    On the other hand, post-industrial culture is disapproving of anything resembling self-doubt that might decrease “productivity,” so it might be understandable that individuals feel there’s something very wrong with them.

    By the way, this is true of the UK as well as the US!

  • Cymbalta has been overhyped for pain as well — see these polls of patients:

    – Cymbalta dead last among 85 treatments for fibromyalgia http://curetogether.com/blog/2011/08/10/patients-say-fibromyalgia-drugs-make-things-worse-rest-is-best/

    – Cymbalta dead last among 35 treatments for neuropathy http://curetogether.com/blog/2011/08/16/neuropathy-study-results-800-people-rate-35-treatments/

    – Cymbalta, Wellbutrin, and other antidepressants very mediocre among 83 treatments for depression (Effexor and Paxil barely effective) http://curetogether.com/blog/category/research-findings/ — exercise, pets, adequate sleep, art therapy, talk therapy rate much higher.

    The “effectiveness” of psychiatric drugs is touted after a drug ekes out statistical significance over placebo. Often it’s only when a new drug enters the market are they compared head-to-head by the challenging pharmaceutical company with the hope their contender will beat the others.

    They are rarely compared to other therapies — in the fibromyalgia poll, the less-expensive but unadvertised generic drug naltrexone is rated much more highly by patients.

    This is another reason why gathering post-marketing data is important.

    From what I’ve seen, Cymbalta easily rivals former withdrawal champions Paxil and Effexor for difficulty in discontinuation. Some people can tolerate a dosage reduction of only one pellet per month.

    Because of its formulation — each pellet is coated; Cymbalta is destroyed by stomach acids — Cymbalta cannot be made into a liquid for tapering.

    I have several people on my Web site who have attempted a gradual taper and found they cannot discontinue Cymbalta at all. They are suffering terribly with side effects nonetheless.

    Cymbalta is utterly oversold for all indications. Its safety has been grossly misrepresented. If the truth were known, it would be considered too dangerous to be prescribed at all.

  • On my site, SurvivingAntidepressants.org, we are definitely seeing people who have anxiety as an adverse effect of psychiatric medications; often their doctors add benzos or buspirone to counter the adverse effects, which do no good whatsoever for the health of their nervous systems.

    Jim Phelps is an extraordinary clinician who has been asking some hard patient-safety questions:

    Med Hypotheses. 2011 Dec;77(6):1006-8. Epub 2011 Sep 14.
    Tapering antidepressants: is 3 months slow enough? http://www.ncbi.nlm.nih.gov/pubmed/21920673

    And, with his colleague Tammas Kelly, on Dr. Phelps’s Web site:

    Stopping Antidepressants in Bipolar Disorder http://psycheducation.org/bipolar/StoppingAntidepressants.htm

    Dr. Phelps has suggested using dark glasses and other blue light-blocking devices to reduce anxiety. Some people experiencing withdrawal-induced anxiety have found this to be helpful.

  • Mental illnesses are not illnesses like any other. Diagnosis is subjective as is effectiveness of treatment.

    Perhaps those attracted to the messiness — the medical students with the more “artistic” temperaments — find the opportunity to unrestrainedly “paint” on another human’s nervous system with chemicals appealing.

    It certainly seems a lot of doctors are thrilled by mixing and matching psychiatric drugs just to see what happens.

    On the other hand, I’m sure there are some truly compassionate, ethical, and responsible people among the medical students attracted to psychiatry. If only every patient could fall into their hands instead of the others.

  • I would also like to point out that increasing exercise will have the most beneficial effect on those who are sedentary.

    Contact with an exercise facilitator won’t do a thing for people who continue to be physically inactive.

  • True. I might have a reflex reaction to any mention of the “big 3” neurotransmitters. Who knows, one of these theories may yet pan out.

    Attributing addiction to dopamine may not imply a drug solution to you, but it means Risperdal Consta to Alkermes! Makes sense to shoot those darned unreliable addicts up with drugs.

  • Stephen Boren, I believe some people do experience antidepressants as effective.

    Generally, drug trials have shown about 1/3 report a beneficial effect, 1/3 no effect, and 1/3 a negative effect — trials have a high dropout rate mostly due to intolerable side effects.

    This corresponds to the “no better than placebo” response Kirsch and others have shown statistically.

    Among those who report a beneficial effect, I believe there are those who experience a placebo effect. Others experience some other kind of chemical influence, perhaps stimulation or sedation, that replaces their initial “depression” and, the way these studies are scored, is reported as resolution of depression.

    I also believe some people are pressured to believe their pills are working when they’re not doing anything except producing side effects.

    There’s no doubt in my mind that ingesting psychiatric pharmaceuticals tends to cause some kind of neurological reaction, just as ingesting MDMA, amphetamine, or LSD causes some kind of neurological reaction.

    The question for the individual is whether that neurological reaction is helpful, bad, or null.

    I would not mistake “no better than placebo” with “no effect at all.”

  • Interesting how dopamine is the neurohormone du jour now that serotonin has had its 15 minutes of fame.

    Or is it that, the mental illness market being saturated, drug companies are now pursuing the lucrative addiction market, softening up public opinion by claiming a pivotal role for dopamine in addiction?

    See this March 2012 US congressional briefing by the Friends of the National Institute on Drug Abuse (NIDA) “co-sponsored by 24 organizations and organized by the APA’s [American Psychological Association’s] Science Government Relations Office” http://www.thefriendsofnida.org/030112_event.asp

    “….The National Institute on Drug Abuse (NIDA) follows a multipronged strategy in researching medications development, focusing on 1) medications already approved for other disorders with potential application to addiction treatment, 2) new compounds that can interact with recently discovered targets in brain circuits affected by addiction, 3) the use of biological agents (e.g. vaccines and engineered enzymes) that retard entry of addictive drugs into the brain, and 4) the combined effects of medications with existing and novel behavioral therapies….”

    This corresponds with recent changes in the DSM-5 enlarging diagnoses of addiction.

    Alkermes, Inc., the pharma behind Risperdal Consta (coincidentally a dopamine antagonist), was a prominent sponsor. Alkermes products http://www.alkermes.com/Products/Key-US-Products and pipeline here http://www.alkermes.com/Research-and-Development/Pipeline

    I would take all the news about the role of dopamine in addiction with a grain of salt, or maybe a shot of Risperdal Consta. My intuition is it’s going to turn out to be “chemical imbalance” redux.

  • The activity of Wellbutrin is more diffuse than SSRIs; its noradrenergic activity is prominent, causing sleeplessness, fast heartbeat, and appetite suppression.

    While side effects are not absent, they tend to be less severe than SSRIs, see http://www.ncbi.nlm.nih.gov/pubmed/11793630

    Buproprion is not as difficult to discontinue, appearing to cause less physiological adaptation than SSRIs.

    Given its lesser firepower, it is not appropriate for “bridging” strategies to assist SSRI or SNRI withdrawal.

    A relative lesser strength does not mean it cannot be effective to alleviate low mood or act as a placebo as well as an SSRI. The methamphetamine-like effect may be welcome by many people.

  • Oh, yes, Wellbutrin, methamphetamine’s weaker cousin.

    What a hypocrisy, prosecuting purchasers of speed, a drug of sin, while dispensing chemical variants that are supposed to be virtuous by way of a prescription pad!

    That speed and its analogs focus a wandering mind and make boring situations a lot more interesting is no secret. Its the way many of us got our college finals done in the ’60s.

    I’m always amazed that methamphetamine analogs are touted breathlessly as therapeutic breakthroughs. Hello, decades of illegal users have already demonstrated all the advantages and disadvantages.

    When children are prescribed meth analogs, how can they be faulted when they get a little older and trade the pills among their friends?

  • The papers at the links I posted above suggest that lengthy or repeated exposure to psychiatric drugs “wears out” the effect, contributing to “treatment-resistant” conditions which may be iatrogenic.

    A person who enters medication treatment with the capacity to learn and change emotional patterns loses that capacity because of medication wear-and-tear on neurons.

  • You’re welcome. You may also be interested in

    El-Mallakh et al, 2011 Tardive dysphoria: the role of long term antidepressant use in inducing chronic depression. http://www.ncbi.nlm.nih.gov/pubmed/21459521

    (Robert Whitaker’s discussion at http://www.psychologytoday.com/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria )

    El-Mallakh et al, 2012 Studies of Long-Term Use of Antidepressants: How Should the Data from Them be Interpreted? http://www.ncbi.nlm.nih.gov/pubmed/22296314

    Amsterdam et al, 2009 Tachyphylaxis after repeated antidepressant drug exposure in patients with recurrent major depressive disorder. http://www.ncbi.nlm.nih.gov/pubmed/19571597

    Uchida et al, 2009 Dosing of antipsychotics in schizophrenia across the life-spectrum. http://www.ncbi.nlm.nih.gov/pubmed/19426777

    In the literature, “poop-out” is known as tachyphylaxis (sometimes tolerance). Wikipedia gives examples of a range of drugs showing tachyphylaxis http://en.wikipedia.org/wiki/Tachyphylaxis

  • See The Crumbling Pillars of Behavioral Genetics http://www.criticalpsychiatry.net/?p=624

    Improvements Are Needed for Accuracy in Gene-By-Environment Interaction Studies, Experts Say http://www.sciencedaily.com/releases/2011/09/110908124614.htm

    Study Says DNA’s Power to Predict Illness Is Limited http://www.nytimes.com/2012/04/03/health/research/dnas-power-to-predict-is-limited-study-finds.html

    The Limits of Genetic Testing http://www.theatlantic.com/health/archive/2012/04/the-limits-of-genetic-testing/255416/

    Genes Show Limited Value in Predicting Diseases http://www.nytimes.com/2009/04/16/health/research/16gene.html

  • Having experienced Paxil “poop-out,” I can say for sure that it exists: A year or so feeling stupefied and demotivated, then out-of-the-blue weepiness etc. very different from my pre-medicated state.

    An antidepressant may be a placebo — a null actor — when it comes to improving mood, but it may have other physiological and cognitive effects that don’t show up on the HAM-D.

    In antidepressants, “poop-out” is thought to indicate maximal serotonergic downregulation. If the nervous system is in that state, you can see how low mood symptoms might emerge. There’s no more juice to squeeze out of the lemon.

    Following “perturbation” theories, “poop-out” might indicate the point at which natural regulatory or compensatory functions are maximal (or overcome, if you follow the more pessimistic interpretation).

    Parallel processes occur with all psychiatric drugs.

  • Sandra, I am confused about “relapse” occurring in the midst of medication.

    If the medication was working, wouldn’t “relapse” be more accurately called “poop-out”? Does “relapse” while medicated occur without “poop-out”?

    Calling such events “relapse” to me is too much like blaming the patient for the flaws of the drug.

    Not only that, the “poop-out” phenomenon, which exists across psychiatric drugs, suggests the medication is doing something untoward in the nervous system, such as excessive down-regulation, and needs to be examined as possibly presaging long-term adverse effects.

  • There is validity in trying to find out what’s happening with the drugs at the cellular level.

    I agree, though, such research is predetermined to support drug prescription — as though finding the drugs actually *do something* to cells is evidence that the something is beneficial.

    Now we may know how the drugs “work” — what bearing does that have on whether they are good or bad for humans?

  • Hey-Hey wrote:
    >We can see how the placebo effect and medication effects both overlap and differ.

    We can? Isn’t this a confound throughout medicine, researchers having a very hard time designing studies that clarify it?

    >We can see the brain variations in those diagnosed with ADHD.

    Really? You wouldn’t be referring to brain scans, would you? See http://www.danielbor.com/dilemma-weak-neuroimaging/

    Maybe it’s a normal developmental stage? Harold Koplewicz http://bigthink.com/ideas/24218 : “And in fact, most often, we see that hyperactivity disappears as someone gets older. And so when they’re in their late adolescence and early adulthood, that symptom seems to go away.”

    >Terms like “chemical imbalance” have just been short-hand reflections of one level of what was thought to be happening at one time. Outdated now.

    Certainly outdated, because it’s now highly public knowledge it’s been nonsense for 30 years. “Short-hand” for what? No biological theory of mental illness has gotten off the ground. Would it be short-hand for “we don’t really know, there’s a pony in here somewhere”?

  • A remarkable challenge to the status quo. Ireland would be very progressive to heed this paper.

    From the paper: “….It seems that while we are comfortable working with individuals and organisations who accept the medical framing of mental problems, we are less willing to contemplate working with critical service users. These are people who reject the medical model because they feel harmed by a system that describes their problems using the language of psychopathology. If we are serious about having an inclusive debate on mental health we will have to overcome this impasse. We need to entertain the idea that people who reject the medical framing of their problems are nevertheless legitimate stakeholders. It is time that we learned how to talk to them and to listen to their ideas. The user movement, with its substantial critical component, is not going to go away….”

  • A lot of people are on meds for a long time because when they tried to go off, they experienced withdrawal symptoms.

    Their doctors tell them that was evidence they’d need the medication to correct their flawed brains for the rest of their lives. The patients become convinced this is so.

    According to the CDC http://www.cdc.gov/nchs/data/databriefs/db76.htm :

    “More than 60% of Americans taking antidepressant medication have taken it for 2 years or longer, with 14% having taken the medication for 10 years or more.”

    That 14% should be studied to find out why they are on medication and whether they have any health problems that can be attributed to long-term use.

  • How would unintended consequences show up, if not as anecdotes? Isn’t that the way many adverse effects becomes recognized?

    Efficacy trials aren’t designed to capture adverse effects, they record them only incidentally. The STAR*D study switched 4,000 people on and off antidepressants yet recorded not a single incidence of withdrawal symptoms — a result that is not credible.

    It would be unethical to design studies to evoke and observe most adverse effects.

    Of necessity, many adverse effects are initially reported anecdotally. For example, see http://www.hbs.edu/research/pdf/09-122.pdf from Harvard Business School:

    “In 1999, the FDA approved Merck’s arthritis drug Vioxx. Through clinical drug trials, Vioxx had been subjected to rigorous tests and careful research. Soon after approval, however, Merck began to receive anecdotal evidence about patients who suffered heart attacks while taking the drug. Of course, many people suffer from cardiovascular disease and heart attacks are multiply determined. How then, should executives at Merck respond? Since Vioxx had already been subjected to rigorous testing, should the “anecdotal evidence” be dismissed? Or, should Merck conduct additional research exploring the possible link between Vioxx and heart disease? And, even before there is definitive proof linking Vioxx and heart disease, is it reasonable for doctors to become more wary of prescribing the drug?

    Locke and Latham (2009) deem anecdotes unworthy of academic attention….

    We profoundly disagree. We think that qualitative analyses, case studies, journalistic accounts, and anecdotes should all be used to raise questions, focus attention, and develop ideas that should be subjected to rigorous, causal analyses.

    We believe that our disagreements with Locke and Latham highlight not only our differences about goal setting, but also about what constitutes good scholarship….”

    And we all know how the Vioxx story turned out!

  • Are there not many, many sites and publications extolling the positives? Why does this site have to provide the same information as a corrective? To be “fair and balanced”?

    Every single injured patient on this site represents someone whose trust in psychiatry has been betrayed — except for those who were forcibly treated. They may not have had any trust in it to begin with.

    How can you give sufficient information for informed consent when you don’t know what the harm quotient is?

    All you can do is make vague personal assurances that everything will be all right.

    Yet when things go wrong for the patient, what does the psychiatrist have to offer? How many have studied reversing iatrogenic damage? How many try to solve the problem by loading on more drugs?

    Prescribing psychiatric medications is shooting in the dark. The only honest informed consent foundation possible: “We don’t know how they work. They help some people and hurt others. I can’t predict which way it will go for you. I won’t be able to fix you if it goes wrong. Do you want this pill now?”

  • I prefer Giovanni Fava’s and Paul Andrews’s theory: The nervous system compensates for the activity of the drug until those natural compensatory or regulatory mechanisms are overcome. At that point, the drug becomes “therapeutic.”

    This also accounts for the fact that many people feel adverse effects of medication very quickly, before “therapeutic” effects.

    It does not contradict the above vesicular theory, the vesicular accumulation being evidence natural compensatory mechanisms are being overwhelmed, as they would normally clear the synaptic vesicles.

  • I’m not seeing any data on the effectiveness of the antidepressants in either study arm; some patients in both groups were on antidepressants and some not.

    The distinction between the groups is “the intervention group were also offered assistance from a physical activity facilitator.”

    Could some patients in each have responded to antidepressants and others didn’t?

    The data are not published with this study.

  • Stephen, that’s true, we read the studies and case reports and we get a full picture of the downside of treatment.

    The information isn’t absent — few in psychiatry look at it. Then they can claim they’ve been kept in the dark.

  • Hey-Hey, patients who’ve already been through the mill with psychiatric drugs and treatments really don’t need to be told, yet again, how wonderful the drugs and treatments are.

    We get it that some people swear by them.

    Efficacy is one question: Do the drugs help people?

    An equally important question: Do the drugs hurt people?

    Only if BOTH questions are answered honestly can a clinician come to a reasonable assessment of risk-benefit for any one person.

    The second question, bearing on patient safety, is not addressed by “positive” anecdotes or even “positive” studies. Misadventure must be examined systematically on its own, to determine causation and frequency.

    What is psychiatry doing to track and analyze adverse outcomes from psychiatric treatment?

    It’s not from lack of p.r. efforts that psychiatry looks bad. It looks bad because its research base is shoddy and it has a lot of dissatisfied customers who will not shut up. Clinical practice manufactures more injured patients every day. You can’t kill bad word of mouth.

  • Providing counseling to pregnant women who are distressed — what a revolutionary idea.

    Only .3% of the 6347 total population or 2.4% of those who received counseling went on to see a psychiatrist. One would hope some number of these were not put on medications.

    These are much better statistics than in the US, where upwards of 2% of all pregnant women are on antidepressants http://www.cdc.gov/ncbddd/pregnancy_gateway/meds/data.html and 27% of pregnant women on Medicaid http://www.ncbi.nlm.nih.gov/pubmed/20360278

  • To supplement Sinead’s observations about akathisia —

    Akathisia exists only as an iatrogenic condition. It does not exist as a condition independent of medication.

    It can be a side effect of medication, or it can be part of psychiatric drug withdrawal syndromes.

    The inner turmoil and agitation of akathisia, which can translate to an unrelenting physical restlessness, defy description. It is a living hell.

    People experiencing this often believe they have truly lost their minds, intuiting profound nervous system damage.

    If a medical professional does not recognize or address akathisia as an iatrogenic condition, such denial of the patient’s reality can make suicide appear to be a valid solution even among the most rational — and some accomplish it.