The article says that children do not outgrow their ADHD diagnosis. However, research shows that many children do this. And 50% more children born in December are treated with ADHD medication than those born in January in the same school class, which is simply because they are more immature.

The article says that people get an explanation for their problems when they receive an ADHD diagnosis. But the diagnosis doesn’t explain anything. It is just a name for a behaviour that lies at one end of a normal distribution for behaviour. Poul behaves in such a way that we choose to call it ADHD. Then we can’t say that ADHD is the reason why Poul behaves like he does. This is circular evidence, also called a tautology.

For the same reason, one cannot have ADHD, which the article claimed. We can have a car or a dog, but not ADHD. It’s not something that exists in nature that can attack us like bacteria can. It’s just a name for a certain behaviour.

It is therefore also misleading to say that 2-3% of middle-aged and older people “live with ADHD.” You can live with a cancer, which really exists, but “living with ADHD” just means living with yourself, which we all do, so this is also an empty statement.

The article mentions that ADHD has a genetic element. Surely, our children resemble ourselves to some extent in the way they behave, but that does not mean that we can find the “disease” (which is not a disease) in the genes. Genetic association studies have not proven anything, and it is not true either that people with ADHD have smaller brains than others, as it was claimed in much touted Lancet article.

The article notes that a named person, diagnosed at age 58, has clearly noticed the effect of the medicine against ADHD. It regulates her mood and behaviour and dampens her many emotional outbursts. Well, this is not exactly what was reported in the randomised trials, but science by anecdotes is very popular among journalists, just as it is among alternative practitioners.

I wrote a short comment to the newspaper, which I expected them to publish, as the article contained factual errors. But oh no! The debate editor wrote to me that they, unfortunately, could not publish it, as the article I referred to did not contain factual errors. “Your appeal is based on your views – and that is of course perfectly fine, but there is no question of erroneous facts on our part – all arguments and statements can be substantiated. But journalist Tea Krogh Sørensen would like to talk to you for a follow-up article about the debate around diagnoses, so I would encourage you to contact her by email.”

I wrote to Tea that I found it “very disappointing that the debate editor writes that there are no errors in the article, when objectively there are errors. It has nothing to do with my ‘views,’ and what I write has nothing to do with opinions, but is based on facts, and there are also logical fallacies (tautologies). I assume you got the information you bring in the article from a psychiatrist.”

We spoke on the phone and when I checked her sources, they confirmed that some children outgrow their diagnosis. So, her article was not correct. The only exception was the patient organisation MIND.

My talk with Tea led nowhere. I tried to convince her that she needed to be critical and not just accept what she was told by leading psychiatrists, and I offered her an easy example. The FDA, based on a meta-analysis of 100,000 patients who had participated in placebo-controlled trials, warns against using depression drugs in children because they increase their risk of suicide. At the same time, leading psychiatrists in Denmark, e.g. professors Poul Videbech and Lars Kessing, claim that the drugs protect children against suicide.

Tea was unable to understand my argument. She said something about different views, and other types of evidence, and when I said randomised trials were the best evidence we have and asked her if she believed more in psychiatrists than in drug regulators, I came nowhere.

Tea said she wanted to interview me, but I shall decline. It can only go wrong. When I explain such simple things to lay people, some of them having no education at all, they always understand me. But journalists? They must be among those with the lowest intelligence of all trades. There are some excellent ones, but my collaboration with average journalists have been intensely frustrating.

The post How Danish Journalism Misleads About Psychiatry appeared first on Mad In America.

In 2013, I estimated that our prescription drugs are the third leading cause of death after heart disease and cancer,¹ and in 2015, that psychiatric drugs alone are also the third leading cause of death.² However, in USA, it is commonly stated that our drugs are “only” the fourth leading cause of death.^3,4 This estimate was derived from a 1998 meta-analysis of 39 US studies where monitors recorded all adverse drug reactions that occurred while the patients were in hospital, or which were the reason for hospital admission.⁵

This methodology clearly underestimates drug deaths. Most people who are killed by their drugs die outside hospitals, and the time people spent in hospitals was only 11 days on average in the meta-analysis.⁵ Moreover, the meta-analysis only included patients who died from drugs that were properly prescribed, not those who died as a result of errors in drug administration, noncompliance, overdose, or drug abuse, and not deaths where the adverse drug reaction was only possible.⁵

Many people die because of errors, e.g. simultaneous use of contraindicated drugs, and many possible drug deaths are real. Moreover, most of the included studies are very old, the median publication year being 1973, and drug deaths have increased dramatically the last 50 years. As an example, 37,309 drug deaths were reported to the FDA in 2006 and 123,927 ten years later, which is 3.3 times as many.⁶

In hospital records and coroners’ reports, deaths linked to prescription drugs are often considered to be from natural or unknown causes. This misconception is particularly common for deaths caused by psychiatric drugs.^2,7 Even when young patients with schizophrenia suddenly drop dead, it is called a natural death. But it is not natural to die young and it is well known that neuroleptics can cause lethal heart arrythmias.

Many people die from the drugs they take without raising any suspicion that it could be an adverse drug effect. Depression drugs kill many people, mainly among the elderly, because they can cause orthostatic hypotension, sedation, confusion, and dizziness. The drugs double the risk of falls and hip fractures in a dose-dependent manner,^8,9 and within one year after a hip fracture, about one-fifth of the patients will have died. As elderly people often fall anyway, it is not possible to know if such deaths are drug deaths.

Another example of unrecognised drug deaths is provided by non-steroidal anti-inflammatory drugs (NSAIDs). They have killed hundreds of thousands of people,¹ mainly through heart attacks and bleeding stomach ulcers, but these deaths are unlikely to be coded as adverse drug reactions as such deaths also occur in patients who do not take the drugs.

The 1998 US meta-analysis estimated that 106,000 patients die every year in hospital because of adverse drug effects (a 0.32% death rate).⁵ A carefully done Norwegian study examined 732 deaths that occurred in a two-year period ending in 1995 at a department of internal medicine, and it found that there were 9.5 drug deaths per 1000 patients (a 1% death rate).¹⁰ This is a much more reliable estimate, as drug deaths have increased markedly. If we apply this estimate to USA, we get 315,000 annual drug deaths in hospitals. A review of four newer studies, from 2008 to 2011, estimated that there were over 400,000 drug deaths in US hospitals.¹¹

Drug usage is now so common that newborns in 2019 could be expected to take prescription drugs for roughly half their lives in USA.¹² Moreover, polypharmacy has been increasing.¹²

How many people are killed by psychiatric drugs?

If we want to estimate the death toll of psychiatric drugs, the most reliable evidence we have are the placebo-controlled randomised trials. But we need to consider their limitations.

First, they usually run for only a few weeks even though most patients take the drugs for many years.^13,14

Second, polypharmacy is common in psychiatry, and this increases the risk of dying. As an example, the Danish Board of Health has warned that adding a benzodiazepine to a neuroleptic increases mortality by 50-65%.¹⁵

Third, half of all deaths are missing in published trial reports.¹⁶ For dementia, published data show that for every 100 people treated with a newer neuroleptic for ten weeks, one patient is killed.¹⁷ This is an extremely high death rate for a drug, but FDA data on the same trials show it is double as high, namely two patients killed per 100 after ten weeks.¹⁸ And if we extend the observation period, the death toll becomes even higher. A Finnish study of 70,718 community-dwellers newly diagnosed with Alzheimer’s disease reported that neuroleptics kill 4-5 people per 100 annually compared to patients who were not treated.¹⁹

Fourth, the design of psychiatric drug trials is biased. In almost all cases, patients were already in treatment before they entered the trial,^2,7 and some of those randomised to placebo will therefore experience withdrawal effects that will increase their risk of dying, e.g. because of akathisia. It is not possible to use the placebo-controlled trials in schizophrenia to estimate the effect of neuroleptics on mortality because of the drug withdrawal design. The suicide rate in these unethical trials was 2-5 times higher than the norm.^20,21 One in every 145 patients who entered the trials of risperidone, olanzapine, quetiapine and sertindole died, but none of these deaths were mentioned in the scientific literature, and the FDA didn’t require them to be mentioned.

Fifth, events after the trial is stopped are ignored. In Pfizer’s trials of sertraline in adults, the risk ratio for suicides and suicide attempts was 0.52 when the follow-up was only 24 hours, but 1.47 when the follow-up was 30 days, i.e. an increase in suicidal events.²² And when researchers reanalysed the FDA trial data on depression drugs and included harms occurring during follow-up, they found that the drugs double the number of suicides in adults compared to placebo.^23,24

In 2013, I estimated that, in people aged 65 and above, neuroleptics, benzodiazepines or similar, and depression drugs kill 209,000 people annually in the United States.² I used rather conservative estimates, however, and usage data from Denmark, which are far lower than those in USA. I have therefore updated the analysis based on US usage data, again focusing on older age groups.

For neuroleptics, I used the estimate of 2% mortality from the FDA data.¹⁸

For benzodiazepines and similar drugs, a matched cohort study showed that the drugs doubled the death rate, although the average age of the patients was only 55.²⁵ The excess death rate was about 1% per year. In another large, matched cohort study, the appendix to the study report shows that hypnotics quadrupled the death rate (hazard ratio 4.5).²⁶ These authors estimated that sleeping pills kill between 320,000 and 507,000 Americans every year.²⁶ A reasonable estimate of the annual death rate would therefore be 2%.

For SSRIs, a UK cohort study of 60,746 depressed patients older than 65 showed that they led to falls and that the drugs kill 3.6% of patients treated for one year.²⁷ The study was done very well, e.g. the patients were their own control in one of the analyses, which is a good way to remove the effect of confounders. But the death rate is surprisingly high.

Another cohort study, of 136,293 American postmenopausal women (age 50-79) participating in the Women’s Health Initiative study, found that depression drugs were associated with a 32% increase in all-cause mortality after adjustment for confounding factors, which corresponded to 0.5% of women killed by SSRIs when treated for one year.²⁸ The death rate was very likely underestimated. The authors warned that their results should be interpreted with great caution, as the way exposure to antidepressant drugs was ascertained carried a high risk of misclassification, which would make it more difficult to find an increase in mortality. Further, the patients were much younger than in the UK study, and the death rate increased markedly with age and was 1.4% for those aged 70-79. Finally, the exposed and unexposed women were different for many important risk factors for early death, whereas the people in the UK cohort were their own control.

For these reasons, I decided to use the average of the two estimates, a 2% annual death rate.

These are my results for USA for these three drug groups for people at least 65 years of age (58.2 million; usage is in outpatients only):^29-32

A limitation in these estimates is that you can only die once, and many people receive polypharmacy. It is not clear how we should adjust for this. In the UK cohort study of depressed patients, 9% also took neuroleptics, and 24% took hypnotics/anxiolytics.²⁷

On the other hand, the data on death rates come from studies where many patients were also on several psychiatric drugs in the comparison group, so this is not likely to be a major limitation considering also that polypharmacy increases mortality beyond what the individual drugs cause.

Statistics from the Centers for Disease Control and Prevention list these four top causes of death:³³

Heart disease: 695,547
Cancer: 605,213
COVID-19: 416,893
Accidents: 224,935

COVID-19 deaths are rapidly declining, and many of such deaths are not caused by the virus but merely occurred in people who tested positive for it because the WHO advised that all deaths in people who tested positive should be called COVID deaths.

Young people have much smaller deaths risk than the elderly, as they rarely fall and break their hip, which is why I have focused on the elderly. I have tried to be conservative. My estimate misses many drug deaths in those younger than 65 years; it only included three classes of psychiatric drugs; and it did not include hospital deaths.

I therefore do not doubt that psychiatric drugs are the third leading cause of death after heart disease and cancer.

Other drug groups and hospital deaths

Analgesics are also major killers. In USA, about 70,000 people were killed in 2021 by an overdose of a synthetic opioid.³⁴

The usage of NSAIDs is also high. In USA, 26% of adults use them regularly, 16% of which get them without a prescription³⁵ (mostly ibuprofen and diclofenac).³⁶

As there seems to be no major differences between the drugs in their capacity to cause thromboses,³⁷ we may use data for rofecoxib. Merck and Pfizer underreported thrombotic events in their trials of rofecoxib and celecoxib, respectively, to such an extent that it constituted fraud,¹ but in one trial, of colorectal adenomas, Merck assessed thrombotic events. There were 1.5 more cases of myocardial infarction, sudden cardiac death or stroke on rofecoxib than on placebo per 100 patients treated.³⁸ About 10% of the thromboses are fatal, but heart attacks are rare in young people. Restricting the analysis to those aged at least 65, we get 87,300 annual deaths.

It has been estimated that 3700 deaths occur each year in the UK due to peptic ulcer complications in NSAID users,³⁹ corresponding to about 20,000 deaths each year in USA. Thus, the total estimate of NSAID deaths is about 107,000.

If we add the estimates above, 315,000 hospital deaths, 390,000 psychiatric drug deaths, 70,000 synthetic opioid deaths, and 107,000 NSAID deaths, we get 882,000 drug deaths in the United States annually.

Many other commonly used drugs than those mentioned above can cause dizziness and falls, e.g. anticholinergic drugs against urinary incontinence and dementia drugs, which are used by 1% and 0.5% of the Danish population, respectively, even though they do not have any clinically relevant effects.^1,2

It is difficult to know what the exact death toll of our drugs is, but there can be no doubt that they are the leading cause of death. And the death toll would be much higher if we included people below 65 years of age. Moreover, from the official number of deaths from heart disease, we would need to subtract those caused by NSAIDs, and from accidents, deaths by falls caused by psychiatric drugs and many other drugs.

If such a hugely lethal pandemic had been caused by a microorganism, we would have done everything we could to get it under control. The tragedy is that we could easily get our drug pandemic under control, but when our politicians act, they usually make matters worse. They have been so heavily lobbied by the drug industry that drug regulation has become much more permissive than it was in the past.⁴⁰

Most of the drug deaths are preventable,⁴¹ above all because most of the patients who died didn’t need the drug that killed them. In placebo-controlled trials, the effect of neuroleptics and depression drugs has been considerably below the least clinically relevant effect, also for very severe depression.^2,7 And, despite their name, non-steroidal, anti-inflammatory drugs, NSAIDs do not have anti-inflammatory effects,^1,42 and systematic reviews have shown that their analgesic effect is similar to that of paracetamol (acetaminophen). Yet, most patients with pain are recommended to take both paracetamol and an NSAID over the counter. This will not increase the effect, only the risk of dying.

Most tragically, leading psychiatrists all over the world do not realise how ineffective and dangerous their drugs are. A US psychiatrist, Roy Perlis, professor at Harvard, argued in April 2024, that depression pills should be sold over the counter because they are “safe and effective.”⁴³ They are highly unsafe and ineffective. Perlis also claimed that depression drugs do not increase the risk of suicide in people older than 25, which is also wrong. They double suicides in adults.^23,24

Perlis wrote that “Some still question the biological basis of this disorder, despite the identification of more than 100 genes that increase depression risk and neuroimaging studies showing differences in the brains of people with depression.” Both these claims are plain wrong. Genetic association studies have come up empty-handed and so have brain imaging studies, which are generally highly flawed.⁴⁴ People are depressed because they live depressing lives, not because of some brain disorder.

References

1 Gøtzsche PC. Deadly medicines and organised crime: How big pharma has corrupted health care. London: Radcliffe Publishing; 2013.

2 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

3 Schroeder MO. Death by prescription: By one estimate, taking prescribed medications is the fourth leading cause of death among Americans. US News 2016; Sept 27.

4 Light DW, Lexchin J, Darrow JJ. Institutional corruption of pharmaceuticals and the myth of safe and effective drugs. J Law Med Ethics 2013;41:590-600.

5 Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA 1998;279:1200–5.

6 FAERS Reporting by Patient Outcomes by Year. FDA 2015;Nov 10.

7 Gøtzsche PC. Mental health survival kit and withdrawal from psychiatric drugs. Ann Arbor: L H Press; 2022.

8 Hubbard R, Farrington P, Smith C, et al. Exposure to tricyclic and selective serotonin reuptake inhibitor antidepressants and the risk of hip fracture. Am J Epidemiol 2003;158:77-84.

9 Thapa PB, Gideon P, Cost TW, et al. Antidepressants and the risk of falls among nursing home residents. N Engl J Med 1998;339:875-82.

10 Ebbesen J, Buajordet I, Erikssen J, et al. Drug-related deaths in a department of internal medicine. Arch Intern Med 2001;161:2317–23.

11 James JTA. A new, evidence-based estimate of patient harms associated with hospital care. J Patient Saf 2013;9:122-8.

12 Ho JY. Life course patterns of prescription drug use in the United States. Demography 2023;60:1549-79.

13 Gøtzsche PC. Long-term use of antipsychotics and antidepressants is not evidence-based. Int J Risk Saf Med 2020;31:37-42.

14 Gøtzsche PC. Long-term use of benzodiazepines, stimulants and lithium is not evidence-based. Clin Neuropsychiatry 2020;17:281-3.

15 Forbruget af antipsykotika blandt 18-64 årige patienter, med skizofreni, mani eller bipolar affektiv sindslidelse. København: Sundhedsstyrelsen; 2006.

16 Hughes S, Cohen D, Jaggi R. Differences in reporting serious adverse events in industry sponsored clinical trial registries and journal articles on antidepressant and antipsychotic drugs: a cross-sectional study. BMJ Open 2014;4:e005535.

17 Schneider LS, Dagerman KS, Insel P. Risk of death with atypical antipsychotic drug treatment for dementia: meta-analysis of randomized placebo-controlled trials. JAMA 2005;294:1934–43.

18 FDA package insert for Risperdal (risperidone). Accessed 30 May 2022.

19 Koponen M, Taipale H, Lavikainen P, et al. Risk of mortality associated with antipsychotic monotherapy and polypharmacy among community-dwelling persons with Alzheimer’s disease. J Alzheimers Dis 2017;56:107-18.

20 Whitaker R. Lure of riches fuels testing. Boston Globe 1998;Nov 17.

21 Whitaker R. Mad in America: bad science, bad medicine, and the enduring mistreatment of the mentally ill. Cambridge: Perseus Books Group; 2002:page 269.

22 Vanderburg DG, Batzar E, Fogel I, et al. A pooled analysis of suicidality in double-blind, placebo-controlled studies of sertraline in adults. J Clin Psychiatry 2009;70:674-83.

23 Hengartner MP, Plöderl M. Newer-generation antidepressants and suicide risk in randomized controlled trials: a re-analysis of the FDA database. Psychother Psychosom 2019;88:247-8.

24 Hengartner MP, Plöderl M. Reply to the Letter to the Editor: “Newer-Generation Antidepressants and Suicide Risk: Thoughts on Hengartner and Plöderl’s ReAnalysis.” Psychother Psychosom 2019;88:373-4.

25 Weich S, Pearce HL, Croft P, et al. Effect of anxiolytic and hypnotic drug prescriptions on mortality hazards: retrospective cohort study. BMJ 2014;348:g1996.

26 Kripke DF, Langer RD, Kline LE. Hypnotics’ association with mortality or cancer: a matched cohort study. BMJ Open 2012;2:e000850.

27 Coupland C, Dhiman P, Morriss R, et al. Antidepressant use and risk of adverse outcomes in older people: population based cohort study. BMJ 2011;343:d4551.

28 Smoller JW, Allison M, Cochrane BB, et al. Antidepressant use and risk of incident cardiovascular morbidity and mortality among postmenopausal women in the Women’s Health Initiative study. Arch Intern Med 2009;169:2128-39.

29 O’Neill A. Age distribution in the United States from 2012 to 2022. Statista 2024;Jan 25.

30 Olfson M, King M, Schoenbaum M. Antipsychotic treatment of adults in the United States. Psychiatrist.com 2015;Oct 21.

31 Maust DT, Lin LA, Blow FC. Benzodiazepine use and misuse among adults in the United States. Psychiatr Serv 2019;70:97-106.

32 Brody DJ, Gu Q. Antidepressant use among adults: United States, 2015-2018. CDC 2020;Sept.

33 Centers for Disease Control and Prevention. Leading Causes of Death. 2024;Jan 17.

34 Drug overdose deaths. Centers for Disease Control and Prevention 2023;Aug 22.

35 Davis JS, Lee HY, Kim J, et al. Use of non-steroidal anti-inflammatory drugs in US adults: changes over time and by demographic. Open Heart 2017;4:e000550.

36 Conaghan PG. A turbulent decade for NSAIDs: update on current concepts of classification, epidemiology, comparative efficacy, and toxicity. Rheumatol Int 2012;32:1491-502.

37 Bally M, Dendukuri N, Rich B, et al. Risk of acute myocardial infarction with NSAIDs in real world use: bayesian meta-analysis of individual patient data. BMJ 2017;357:j1909.

38 Bresalier RS, Sandler RS, Quan H, et al. Cardiovascular events associated with rofecoxib in a colorectal adenoma chemoprevention trial. N Engl J Med 2005;352:1092-102.

39 Blower AL, Brooks A, Fenn GC, et al. Emergency admissions for upper gastrointestinal disease and their relation to NSAID use. Aliment Pharmacol Ther 1997;11:283–91.

40 Davis C, Lexchin J, Jefferson T, Gøtzsche P, McKee M. “Adaptive pathways” to drug authorisation: adapting to industry? BMJ 2016;354:i4437.

41 van der Hooft CS, Sturkenboom MC, van Grootheest K, et al. Adverse drug reaction-related hospitalisations: a nationwide study in The Netherlands. Drug Saf 2006;29:161-8.

42 Gøtzsche PC. Big marketing hoax: Non-steroidal, anti-inflammatory drugs (NSAIDs) are not anti-inflammatory. Copenhagen: Institute for Scientific Freedom 2022;Nov 10.

43 Perlis R. The time has come for over-the-counter antidepressants. Stat News 2024;April 8.

44 Gøtzsche PC. Critical psychiatry textbook. Copenhagen: Institute for Scientific Freedom; 2022. Freely available.

The post Prescription Drugs Are the Leading Cause of Death appeared first on Mad In America.

The pill nearly killed her and took her away from her kids, which Katinka has described in her book, “The pill that steals lives.” She also made a very moving 8-minute film about her own story that I recommend everyone with an interest in psychiatry to see, and she has an interesting homepage, with links to documentaries and with stories about people who killed themselves or others or were seriously harmed by the pills.

Katinka started hallucinating wildly, thinking in very violent images, and imagined she had stabbed herself in the stomach. She took a kitchen knife and lacerated her left arm. She became convinced she had stabbed and killed her two children, Lily and Oscar, 12 and 11 years old, respectively. Nothing really mattered, and it was pure luck that she didn’t kill herself or someone else, as she had no sense of reality.

Katinka ended up in a private psychiatric hospital in central London, Florence Nightingale. The psychiatrists didn’t realise it was the pill that had made her ill. They diagnosed psychotic depression and forced her to stay and take more drugs.

Oscar says in the film that after three months on antidepressants and antipsychotics, his mom had no emotions and walked around like a robot in a very dirty dressing gown for a whole year.

Katinka couldn’t hold a conversation and wasn’t interested in anything. The worst thing was that she couldn’t feel anything, couldn’t even feel any love for her children.

After a year, Katinka was on seven different drugs, including two neuroleptics (olanzapine and quetiapine), a depression pill (fluoxetine), an anti-epileptic (lamotrigine), lithium, a sleeping aid (zopiclone) and a couple of benzodiazepines to be used if the other drugs were not enough to knock her down.

Her psychiatrists insisted she had treatment-resistant depression. They didn’t realise they had caused her condition themselves. Who would not become depressed on such a drug cocktail? It is considered malpractice to give more than one neuroleptic simultaneously, which increases mortality for no benefit, and it is also bad medicine to give several minor tranquillisers, and indeed for more than a couple of weeks.

Then, her private insurance ran out, and she was admitted to a public hospital where they stopped all the drugs cold turkey. This was also serious medical malpractice. It is very dangerous to stop psychiatric drugs abruptly, which can cause akathisia, suicide and homicide.

But Katinka’s so-called illness disappeared in just three weeks. She was able to love her children again and look them in the eyes.

Oscar says in the film: “All along, I have been saying to everyone: It’s the pills. No one would believe that you get medicines, and they would make you crazy and psychotic, and I just thought, this has to stop.”

So, a small boy knew what caused his mom’s problems while highly paid psychiatrists at a private hospital harmed her indescribably and gave her a totally wrong diagnosis, psychotic and treatment-resistant depression.

At the book launch in 2016, which I attended, Katinka said she was very lucky to be there alive, and not serving a life sentence for killing her children.

As an introduction to her book, I write: “This book describes in vivid detail how ordinary people can become murderers if they take antidepressant drugs and how psychiatry can destroy people. It is a catching personal testimony about what is wrong with psychiatry, its love affair with unscientific diagnoses and harmful drugs, and its blindness towards the fact that what look like psychiatric diseases are often side effects of psychiatric drugs.”

A mother in Holland did not have the luck Katinka had. When Katinka published her book, I was an expert witness in a double homicide case in Holland where I emphasised that serious professional malpractice played a crucial role. Aurélie Versluis had killed her two children with a knife while having indisputable symptoms of akathisia on paroxetine (Seroxat or Paxil, from GlaxoSmithKline) but her pleas for help were ignored. After three months on the drug, she became suicidal but instead of withdrawing it, her psychiatrist advised continued use.

Aurélie told two people about nightmares where she slit her children’s throats (which she ultimately did, and also tried to commit suicide). Two days prior to the homicides, she reported to her supervisor that she was ill and told several people that she was not feeling well. She visited her family doctor (who had prescribed paroxetine) with her complaints and her company doctor who dismissed her. Finally, she contacted her psychologist who did not have time for her.

It is a gruesome story. She was not herself, which a forensic psychiatrist confirmed three days after the homicides. And her doctors continued to harm her. They stopped paroxetine cold turkey when she was in the psychiatric penitentiary six months after the homicides, causing serious harm that persisted for five months.

I did my best in court, but the judges failed to understand that those who should have been accused were Aurélie’s psychiatrists, not her. She should have been released because of drug-induced insanity. They sentenced her to 9 years in prison, but questions were raised in parliament if the judicial system was too harsh. It surely was. In these cases, it is very rare that judges do anything other than accepting the explanations of the psychiatrists, even though they have a huge conflict of interest when they defend themselves or their colleagues in a system that is sick.

The post On the Brink of Murder Because of an Antidepressant appeared first on Mad In America.

The three trial reports seriously underreported suicide attempts, other suicidal events, and precursors to suicide and violence on active drug, and provided false claims that the drugs were effective.

We wrote to the editors of Journal of the American Academy of Child & Adolescent Psychiatry and JAMA Psychiatry (previously Archives of General Psychiatry) that,

“By retracting the fraudulent trial reports and explaining why in accompanying editorials, you will provide a much-needed service to the scientific community and the world’s citizens, which will reduce the risk of additional meaningless suicides in children and young people. If you don’t act, you will not only sully the reputation of your journals. You will also be seen as being complicit in future suicides caused by antidepressants as a direct harm of these drugs.”

We provided trial evidence that antidepressants not only increase the risk of suicide but also increase actual suicides, even in adults. We cited research based on the clinical study reports the manufactures had submitted to drug regulators to get their drugs approved for children and adolescents and other research in our letter.

Two fraudulent fluoxetine trials

There were two fraudulent fluoxetine trials in depression. I reviewed the clinical study reports and other research extensively and published my observations with David Healy as co-author.¹

None of the two peer-reviewed publications, which had Graham Emslie as first author,^2,3

described the suicidal events that were mentioned in the clinical study reports, X065 and HCJE, respectively.^4,5 I asked Emslie and the manufacturer, Eli Lilly, if they wanted to restore the trials. Emslie did not reply, and Lilly did not believe that “any additional analyses are needed at this time.”

The fraud was grave. In trial X065,⁴ 2 of 48 children (4%) attempted suicide on fluoxetine, but these suicide attempts were left out from the published report.

The clinical study report for trial X065 revealed that 32 of 48 children on fluoxetine versus 18 of 48 children on placebo experienced at least one adverse event (P = 0.008); 19 versus 6 experienced restlessness (P = 0.005), 9 versus 1 had nightmares (P = 0.02), and 7 versus 4 felt tense inside. These harms increase the risk of suicide and violence, but the published article did not present any such data. Only 49 words in the Results section were related to safety and it was only about discontinued children.

The efficacy analyses were also seriously flawed in favour of fluoxetine and there were numerical discrepancies that amounted to mathematical impossibilities. Despite this, the benefits, as measured by the psychiatrists, were so small that they lacked clinical significance, and the children found fluoxetine ineffective. Emslie et al. concluded in their published trial report of study X065 that fluoxetine is safe and effective, but the truth is that fluoxetine is unsafe and ineffective.

The fraud was also grave for trial HCJE, in which 109 children or adolescents with depression were randomised to fluoxetine and 110 to placebo. The clinical study report revealed that more children on fluoxetine than on placebo experienced severe adverse events to such an extent that, for every 10 children treated with fluoxetine, one was severely harmed. Nine versus 5 children had severe problems with sitting still, which Eli Lilly did not comment on although it could mean akathisia.

After 19 weeks, 42 children on fluoxetine versus 28 on placebo had experienced nervous system events (P = 0.01). By treating only 6 children with fluoxetine instead of placebo, one additional child will be harmed. Fluoxetine reduced the increases in height and weight by 1.0 cm and 1.1 kg, respectively (P = 0.008 for both). There were no data about these important harms in the published article.

In the clinical study report, Lilly concluded that fluoxetine is safe and praised its benefits and lack of harms, with no mention that the children did not find fluoxetine effective.

Taking the two studies together, adverse events definitely predisposing to violence against self or others leading to discontinuation occurred in 11 versus 3 children.

One of the strongest precursors for violence against self or others is akathisia. In an exploratory analysis that included akathisia and other potentially related symptoms, there were 37 versus 32 such adverse events in trial X065 and 51 versus 24 after 19 weeks in trial HCJE.

In the published trial report of study HCJE, Emslie et al. concluded that fluoxetine appears to be well tolerated and effective. This is blatantly false. Fluoxetine was badly tolerated and ineffective.

When the FDA assessed Lilly’s application for treatment of children and adolescents with fluoxetine, they included a table of discontinuations because of adverse events in X065, HCJE and HCJW, which was a trial of obsessive-compulsive disorder comparing fluoxetine with placebo for 13 weeks in 71 versus 32 children. There were 14 versus 3 discontinuations (P = 0.02) among the 228 versus 190 children for reasons related to suicide and violence (suicide attempt, euphoria, manic reaction, agitation, hyperkinesia, nervousness, personality disorder, hostility, and depression).^1,6 There were 3 suicide attempts on fluoxetine and 1 on placebo, and another child on fluoxetine was hospitalised because of suicidality. Six children on fluoxetine developed mania or hypomania versus none on placebo (P = 0.03). A table of spontaneously reported adverse events in HCJW and HCJE (9 weeks data) showed that more children developed hyperkinesia on fluoxetine than on placebo, 12 versus 1 children (P = 0.008). This is a serious harm, as akathisia is often miscoded as hyperkinesia.⁷

A fraudulent paroxetine trial

In study 329 by Martin Keller et al., 93 adolescents with depression were randomised to paroxetine and 87 to placebo in an 8-week period (a third group received imipramine).⁸

In the published report, Keller et al. concluded that paroxetine is generally well tolerated and effective. It was neither of this. Independent researchers who had access to the clinical study report⁹ and additional data found very different results.¹⁰

Keller et al. reported that 5 versus 1 children had suicidal or self-injurious behaviours whereas the independent researchers found 11 versus 1 children (P = 0.005). Keller et al. and the clinical study report by SmithKline Beecham had mostly misreported suicide related events as “emotional lability.”

The independent researchers found that 32 versus 6 children had adverse events deemed serious by the investigators (P = 0.000006) and that 14 versus 6 children withdrew from the trial because of adverse events. Keller et al. reported that only 9 versus 6 children withdrew from the trial because of adverse events.

The independent researchers found that the efficacy of paroxetine was not statistically or clinically significantly different from placebo for any prespecified primary or secondary efficacy outcome. But changes were made post-hoc to some of the outcomes, both before and after breaking the blind, without being stated in any of the protocol amendments or in the published article, whereby they became statistically significant. This is fraud.

The reactions

On 21 September 2023, Anette Flanagin, Executive Managing Editor, Vice President, Editorial Operations JAMA and JAMA Network, sent this reply:

“We shared your letter with the author of the study published in Archives of General Psychiatry and he does not identify any new concerns. Similarly, we do not find new evidence in support of your request to retract this article.”

So, JAMA and Emslie, who omitted two suicide attempts on fluoxetine and made numerous other errors, do not think this is something to bother about. Flanagin asked the person responsible for the fraud of his views and when he says there is nothing wrong, she accepts this, even though we had demonstrated the fraud. I wonder if Flanagin would recommend this method for the police when they investigate serious crime dangerous for persons.

We kindly asked Flanagin, in the public interest, to reconsider her decision not to retract Emslie’s paper. And, if she still didn’t want to do this, then publish an erratum explaining that what was published was seriously misleading and that many of the numbers presented in the article contrasted with the numbers in Eli Lilly’s clinical study report about the same trial. We also asked Flanagin to give us the opportunity to publish an account of the many errors in Emslie’s article, asking him to respond in the same issue. Finally, we asked Flanagin to forward to us Emslie’s reply to her where he indicates that there is nothing to be concerned about in his article.

We emphasised it was Flanagin’s ethical duty towards the children and their relatives to do this, and that she might also want to avoid JAMA Psychiatry to be seen as being complicit in future suicides caused by antidepressants as a direct harm of the drugs. In our letter to Flanagin, we provided a link to the clinical study report so that she could check for herself that two suicide attempts had been left out of the published report.

Flanagin did not respond. When I contacted the journal’s owner, Elsevier, they did not engage with our concerns but directed me back to the journal.

On 13 February 2024, Douglas K. Novins, Editor-in-Chief, Journal of the American Academy of Child & Adolescent Psychiatry (JCAAP), wrote to me:

“Following guidelines developed by the Committee on Publication Ethics (COPE), independent groups comprised of members of the JAACAP senior editorial team have now thoroughly reviewed your critique, as well as the responses provided by the papers’ authors. We are satisfied that the critiques of the papers as outlined do not merit retraction.”

I sent a similar message to Novins as my appeal to Flanagin but he did not reply.

It is hard to see how Novins could have followed the guidelines developed by the Committee on Publication Ethics (COPE), as the two trial reports, by Emslie and Keller, are clearly fraudulent.

In 2009, Leemon McHenry and Jon Jureidini wrote to the then editor of JAACAP, Dr. Andrés Martin, and asked him to retract study 329, as it violated the journal’s own rules about scientific misconduct:

Failure to disclose financial conflict of interests; GSK’s intent to deceive (concealing commercially damaging data) via the ghost authoring company; fabrication (creation of a false primary outcome measure); falsification (misrepresentation of primary and secondary measures and serious adverse events); and plagiarism (insofar as submitting a ghostwritten manuscript is a form of plagiarism).

In 2011, McHenry and Jureidini informed all the 22 authors of study 329 of the fraud and asked them to write to JAACAP to have the paper withdrawn, or at least to withdraw their own names as authors. They also, with many co-signatories, wrote to President Ruth J. Simmons from Brown University where Keller worked alerting her to the serious breach of the university’s own rules, noting that the unretracted article is a stain on Brown University’s reputation for academic excellence, and asking her to write to JAACAP supporting their request for retraction.

In 2012, the editor-in-chief of JAACAP, Andrés Martin, wrote to Jureidini: “Following the June 27, 2012 settlement between GlaxoSmithKline and the U.S. Department of Justice, the Journal’s editorial team undertook a thorough evaluation of the article, the legal settlement, and related materials. The authors of the article were contacted and asked to respond to the questions and concerns raised by the settlement. After a comprehensive and extensive review, the Journal editors found no basis for retraction or other editorial action. Due to the nature of the concerns and serious consideration given to the situation, the evaluation process was quite lengthy, and we appreciate your patience while the editorial team conducted its review. The inquiry is considered complete, and as such, your letter will not be published in the Journal.”

In 2013, The Executive Committee of the Northern California Regional Organization of Child and Adolescent Psychiatry wrote a letter to the Ethics Committee at the American Academy of Child and Adolescent Psychiatry, the owner of JAACAP. They noted that FDA’s Clinical Review of study 329 considered it a failed trial, in that neither active treatment group showed superiority over placebo. But publicly, study 329 was called “cutting edge research” demonstrating “REMARKABLE” results, and by 2010, there were an estimated 184 citings of the paper in the medical literature, suggesting its widespread influence.

The Executive Committee noted it was troubling that the journal has not retracted “the demonstratedly fraudulent article” and that three of the members were told that the Ethics Committee was instructed not to investigate the paper. They formally requested that the Ethics Committee conduct a full investigation and furthermore noted:

“There is nothing in our By-Laws to prevent such an investigation. In fact, the Mission of the Academy encourages it: ‘To promote the healthy development of children, adolescents, and families through research, training, advocacy, prevention, comprehensive diagnosis, and treatment.’”

Absolutely nothing came out of their initiative either. They were fobbed off with a lecture about “editorial independence” and a patronising dismissal: “I have talked with [the Editor] and he assures me there is no cause for concern.”

A fraudulent citalopram trial

In 2004, Karen Wagner et al. published a fraudulent trial report in American Journal of Psychiatry owned by the American Psychiatric Association.¹¹ It claimed that citalopram significantly improved depressive symptoms compared with placebo in children and adolescents.

But the drug was not better than placebo. The evidence for misreporting and data manipulation was revealed in a class action lawsuit, The Celexa and Lexapro Marketing and Sales Practice Litigation, and published by Jay Amsterdam, Jon Jureidini and Leemon McHenry in 2016.¹²

The manuscript was ghostwritten, and Forest Laboratories, Lundbeck’s US partner, seriously misrepresented both the effectiveness and the safety of citalopram. Forest’s internal documents showed that company staff were aware of the problems. Contrary to the study protocol, children that should have been excluded were included in the analyses to produce statistical significance for the primary outcome measure; an implausibly large effect size was claimed, which was subsequently proven wrong; positive post hoc outcomes were introduced while negative primary and secondary outcomes were not reported; and adverse events were misleadingly analysed, hiding substantial agitation in the citalopram group.

Declassified court documents revealed that Forest intentionally misled the FDA about study protocol violations that invalidated the claim that the study was positive.

In 2016, Amsterdam, Jureidini and McHenry asked Wagner to write to the editor and request him to retract the paper, or at least to withdraw her own name from the article. She didn’t reply.

They asked the current editor, Robert Freedman, to retract the article. When he refused, they asked the editor who accepted the paper, Nancy Andreasen, to support retraction of the article, but she didn’t reply.

They also informed Maria A. Oquendo, President of the American Psychiatric Association, about the scientific misconduct and asked her to take action. She didn’t reply.

Absolutely nothing was done.

Consequences of the fraudulent trials

The consequences of the fraudulent trials are huge, and the fraud is not limited to trials of fluoxetine, paroxetine, and citalopram.⁷ They are all over the place in this area but these drugs just happened to be the ones where the fraud has been most closely examined.

When my research group did a systematic review of placebo-controlled antidepressant trials (all ages) based on clinical study reports, we also found highly disturbing data.¹³ For children and adolescents, the odds ratios were 2.39 (95% confidence interval 1.31 to 4.33) for suicidality, 2.79 (1.62 to 4.81) for aggression, and 2.15 (0.48 to 9.65) for akathisia (which was underreported because of miscoding).

Patient narratives were only available for serious events and for aggression. They included homicidal threat, homicidal ideation, assault, sexual molestation, a threat to take a gun to school, damage to property, punching household items, aggressive assault, verbally abusive and aggressive threats, and belligerence. Such harms are not likely to ever appear in published trial reports.

It is a fatal mistake to believe that antidepressants are safe and effective. Many children and young people who were driven to suicide by the harms of the antidepressant they took did not even have a condition that justified the prescription, e.g. their problem could be insomnia, stress at work, anxiety before a school exam, or break-up with a girlfriend.⁷

It is characteristic for antidepressant induced suicide that people choose highly violent means, e.g. hanging or shooting.⁷ They feel so terrible because of the harms of the pills that they want to ensure they will end their lives. In contrast, people who attempt suicide because of depression often use other means, e.g. an overdose of pills, which gives them a chance of surviving and is usually a cry for help.

Prestigious psychiatric journals, psychiatrist investigators and professional organisations do not live up to their academic and ethical responsibilities. They seem to be totally reckless, as they don’t care that their activities make them complicit in suicides among children and in harming them in numerous other ways with drugs that don’t work for them. None of the many authors on the fraudulent trial reports have asked to have their name removed.

A 2022 meta-analysis of placebo-controlled trials funded by industry that included 6161 children and adolescents found a tiny effect size, only 0.12, using the Children’s Depression Rating Scale-Revised (CDRS-R).¹⁴ An effect this small does not have any clinical meaning.⁷ We therefore know with great certainty that depression pills do not work for depression in young people. But they double their risk of suicide.^15,16

We should stop publishing in psychiatric journals. They are too corrupted by financial and other conflicts of interest, which is one among several reasons why some of us now prefer to publish on websites where there is no censorship.¹⁷ Psychiatric journals constitute what three US child and adolescent psychiatrists that were appalled by the ubiquitous corruption called “Liars’ club.”

It is disgraceful that children are treated with depression drugs. This should be made illegal and the companies and the psychiatric journals should be sued for consumer fraud with lethal consequences.

References

1 Gøtzsche PC, Healy D. Restoring the two pivotal fluoxetine trials in children and adolescents with depression. Int J Risk Saf Med 2022;33:385-408.

2 Emslie GJ, Rush AJ, Weinberg WA, et al. A doubleblind, randomized, placebo-controlled trial of fluoxetine in children and adolescents with depression. Arch Gen Psychiatry 1997;54:1031-7.

3 Emslie GJ, Heiligenstein JH, Wagner KD, et al. Fluoxetine for acute treatment of depression in children and adolescents: a placebo-controlled, randomized clinical trial. J Am Acad Child Adolesc Psychiatry 2002;41:1205-15.

4 Eli Lilly and Company. Protocol B1Y-MC-X065. Clinical study main report: Fluoxetine versus placebo in the acute treatment of major depressive disorder in children and adolescents. 2000.

5 Eli Lilly and Company. Protocol B1Y-MC-HCJE. Clinical study report: Fluoxetine versus placebo in childhood/adolescent depression. 2000.

6 Mosholder AD. Application number: 18-936/SE5-064. Medical review. FDA 2001.

7 Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

8 Keller MB, Ryan ND, Strober M, et al. Efficacy of paroxetine in the treatment of adolescent major depression: a randomized, controlled trial. J Am Acad Child Adolesc Psychiatry 2001;40:762-72.

9 SmithKline Beecham. A multi-center, double-blind, placebo controlled study of paroxetine and imipramine in adolescents with unipolar major depression – acute phase, Final clinical report 1998;Nov 24.

10 Le Noury J, Nardo JM, Healy D, et al. Restoring Study 329: Efficacy and harms of paroxetine and imipramine in treatment of major depression in adolescence. BMJ 2015;351:h4320.

11 Wagner KD, Robb AS, Findling RL, et al. A randomized, placebo-controlled trial of citalopram for the treatment of major depression in children and adolescents. Am J Psychiatry 2004;161:1079-83.

12 Jureidini JN, Amsterdam JD, McHenry LB. The citalopram CIT-MD-18 pediatric depression trial: Deconstruction of medical ghostwriting, data mischaracterisation and academic malfeasance. Int J Risk Saf Med 2016;28:33-43.

13 Sharma T, Guski LS, Freund N, Gøtzsche PC. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ 2016;352:i65.

14 Feeney A, Hock RS, Fava M, et al. Antidepressants in children and adolescents with major depressive disorder and the influence of placebo response: A meta-analysis. J Affect Disord 2022;305:55-64.

15 Laughren TP. Overview for December 13 Meeting of Psychopharmacologic Drugs Advisory Committee (PDAC). FDA 2006;Nov 16.

16 Hammad TA, Laughren T, Racoosin J. Suicidality in pediatric patients treated with antidepressant drugs. Arch Gen Psychiatry 2006;63:332-9.

17 Gøtzsche PC. Why some of us no longer want to publish in prestigious medical journals. Copenhagen: Institute for Scientific Freedom 2023;Nov 14.

The post Medical Journals Refuse to Retract Fraudulent Trial Reports That Omitted Suicidal Events in Children appeared first on Mad In America.

Silas Dam killed himself this summer, only 24 years old. But in his short lifetime, he made a contribution that will benefit many psychiatric patients in Denmark. He entered a settlement with the Ministry of Health in December 2021, which obliged the government to amend the Psychiatry Act, so that the rights for psychiatric patients subjected to belt fixation were improved. Silas also got the ministry to commit to making an effort to improve the treatment of people with autism.

Silas had autism and came into contact with the psychiatric system at a very young age. He was admitted to hospital several times and spoke openly about his experiences with the aim of improving the treatment that people with autism receive when they meet the psychiatric system.

He argued that people with autism were mistreated and greatly harmed when they—voluntarily or forcibly—were treated with strong neuroleptics that made them feel worse. He pointed out that people with autism can have anxiety attacks and panic attacks, which may require sedative medication, but they generally do not become psychotic and therefore do not need to be treated with neuroleptics.

Silas experienced himself the harms of forced medication and restraints with belts. At the beginning of 2019, he was subjected to belt fixation at a psychiatric ward. He considered it unjustified, and although it was approved by both the district court and the high court, he brought the case to the European Court of Human Rights in Strasbourg with the help of a lawyer.

For another Danish patient, the Court had ruled that the belt fixation he had experienced was in violation of the Human Rights Convention’s prohibition against inhumane treatment, as it continued even though the patient was completely calm.

Silas’ case was very similar, and to avoid another defeat at the Court in Strasbourg, the Ministry of Health offered him a settlement with a compensation of DKK 90,000. But the money was not important for Silas. He wanted the settlement to benefit other patients and demanded that the Ministry of Health acknowledge that the belt fixation was a violation of human rights, which documented serious problems in the psychiatric wards.

Silas also demanded that the Psychiatry Act be amended so that the permanent guards who keep an eye on belt-fixated patients were required to make notes about the patient’s condition several times every hour. And he insisted that the government should ask the National Board of Health to draw up an action plan for autism.

After a lengthy negotiation, the Ministry of Health accepted Silas’ demands. The Psychiatry Act was amended, and guards must now make a note every 15 minutes about whether a belt-fixated patient shows signs of danger or not. If the patient is calm, he or she must be released from the belts.

In Iceland, seclusion and restraint were abolished in 1932 and never used again. That year, psychiatrist Helgi Tómasson took the shackles, straightjackets and other physical restraints that existed in the mental hospital, Kleppur, and burnt them in a furnace—all except one set, which he sent to the Parliament where it is still on display. This should be done in all countries.

For his efforts, Silas received a very prestigious award, the Kafka award, which is given to a person who has made a special effort to strengthen the legal position of weak social groups in society.

Silas lived in a youth home for the last period of his life. He was proud to receive this honor but was stigmatised by his experiences and sometimes found it difficult to thrive. He therefore chose to end his life. In a farewell letter, he apologised to his parents and relatives and explained why it had to end that way for him. The note read: “Psychiatry killed me, belt fixation killed me, forced medication killed me.” He added: “Share my story.”

Silas’ mother contacted me in October and wrote: “I witnessed what the psychiatric drugs did to him. He described it carefully. I hope that you will want to hear about the side effects and possibly use the information in your lectures. I do not think his case, despite his passing, is over yet.” In another email, his mother explained:

“Silas fought with everything he had in him right to the end. During the belt fixation, he was forcibly medicated with both Abilify and Stesolid [diazepam] at the same time. In addition to the horror of having a towel stuffed in his mouth, he described that the medication made him drowsy, everything spun around, like standing on a merry-go-round where you have no option of getting off. He was given additional forced medication, which meant that he could not remember his mother, father or siblings for six months. The memory gradually returned and he started a battle so that others would not have to go through what he had gone through. Psychiatry could not recognize an autistic anxious meltdown and therefore forcibly medicated him, without entering a dialogue, with psychosis medication. However, the medicine had done irreparable damage. He couldn’t sleep or get his head straight. The way to get off the carousel turned tragic. My son has told of another inpatient who was so wrecked by medication that he trudged on the floor all day drooling and couldn’t even hold his cutlery when he had to eat.”

Silas was killed by psychiatry. I have described on Mad in America that Tuva Andersson, whose problem was anxiety, was also killed by psychiatry. Millions of people have been killed by psychiatry, many of them through forced treatment. Why do we accept this?

In 2014, the United Nations Special Rapporteur Dainius Pūras, who is a psychiatrist, called upon all nations to make forced treatment illegal, but not a single country has done anything. Recently, the UN Office of the High Commissioner on Human Rights declared his work “groundbreaking,” but leading psychiatric organisations have been very hostile and disdainful. A common linguistic strategy was to represent the special rapporteur, and, by association, the United Nations, as unscientific and biased while current practice in psychiatry was presented as intrinsically scientific and ethical.

The reactions to Pūras’ reports by psychiatric organisations have been analysed in an instructive article. They included the usual falsehoods, e.g. that antipsychotics emptied the asylums and made it possible for people to live normal lives, and that “pharmacological treatments have been shown to reduce the risk for suicide” (avoiding mentioning which drugs they were), with no references, only vague statements like “an extensive body of data.” The correct, so-called assumption that psychiatry is guilty of human rights violations was called “absolutely slanderous as it attacks an entire professional community without distinction and—what is more—is absolutely not evidence-based.”

The reactions were full of strategic ignorance, in which the psychiatric organisations appeared to be completely ignorant of any evidence that psychiatric drugs do harm—a tactic enabling denial of liability. There was also a lot of conceptual “bullshitting” in which “rituals of politeness are foregone entirely, and we are faced with the raw assertion of power or authority in brusque gestures and commanding tones” with false statements like, “Advances in neuroscience are occurring at a remarkable pace.” Not unless one by remarkable pace means close to a standstill, as far as value for patients is concerned.

Sorry for being blunt but this must be said: The psychiatric profession continues to kill their patients in huge numbers and get insulted when the United Nations tries to stop it. This is a profession beyond repair. It should be closed down. Immediately, as an emergency.

The post A Remarkable Feat: A Psychiatric Patient Changed the Law on Restraints appeared first on Mad In America.

This information is not entirely accurate. The effect of the medicines does not start after a given number of days but comes very gradually. Even after six weeks, which is the trial duration in most trials, the difference in depression symptoms between active substance and placebo is so small that it is less than what psychiatrists consider clinically relevant. Therefore, many so-called critical psychiatrists believe the medication does not actually have any beneficial effect on depression.

It is misleading to say that suicidal thoughts may increase at the start of treatment. They can come at any time, especially at times of dose changes, either increases or decreases, which the US Food and Drug Administration (FDA), but unfortunately not the Danish Medicines Agency, therefore warns about.

It is also wrong to give the impression that the increased risk of suicide stops when you turn 25. When the FDA analysed all the trials in 2006, there was a curve in their report that showed that the suicide risk increased right up to the age of 40.

The placebo-controlled trials show that the suicide risk of depression medication is doubled in children and young people. This has been known for 17 years. In 2019, a new analysis came out that included what happened after the patients had stopped their participation in the trial. It turned out that the medication, also in adults, not only doubles the risk of suicide, but also completed suicides. The analysis reflects reality, because in clinical practice you also stop taking the medication at some point.

Thus, we have solid knowledge—from the most reliable research that exists, the placebo-controlled trials—that depression drugs double the risk of suicide and completed suicides, and that there is no age limit.

However, the official narrative all over the world is the exact opposite. The storyline is that depression drugs protect against suicide.

Recently, one of my colleagues did a Google search on “suicide and antidepressants” (in Danish), and one of the top entries was from Psychiatry in the Capital Region claiming that antidepressants do not increase the risk of suicide or violence.

I repeated the search on 25 September to find out to which extent the public is being misinformed. It turned out to be very massive and systematic. I describe here the top 10 entries.

At the very top was a report from the Centre for Suicide Research. The researchers found that antidepressants increase the risk of repeated suicide attempts by 50%, but they then adjusted their analyses for a wide range of factors such as having children under 15, age, sex, occupation, psychiatric contact and use of various psychiatric drugs. After this, they concluded: “This study shows that the use of antidepressants, including SSRIs, in the time after a suicide attempt does not increase the statistical probability of repeating one’s suicide attempt.”

It is elementary knowledge that it is statistically completely wrong to adjust for something that is part of the causal chain. Serious mental illness can lead to psychiatric contact and the use of other psychiatric drugs and to a suicide attempt. When you adjust for causal factors in the causal chain, you can make a true correlation disappear completely. This mess was supported financially by Lundbeck, a Danish drug company that sells several antidepressants, and whose director once claimed in a radio broadcast that antidepressants protect against suicide.

Number two on the list was a message addressed to Danish citizens from Psychiatry in the Capital Region with the title, “Risk of suicide and violence is not affected by antidepressant therapy.” They referred to a Danish registry study, and there were no reservations whatsoever about the conclusion. This was serious misinformation of the public. Registry studies are biased in numerous ways and, of course, cannot invalidate the results obtained in placebo-controlled trials, which clearly show that antidepressants increase the risk of both suicide and violence.

Number three was even worse. Psychiatry in the Capital Region stated in the headline that “Antidepressants do not increase the risk of suicide” and in the subheading that “Fluoxetine and venlafaxine do not increase the risk of suicide among young people. Among adults and the elderly, the drugs protect against suicide.” They referred to a highly unreliable meta-analysis by Gibbons from 2012, which, according to psychiatrist David Healy, is a concoction of an earlier meta-analysis from 1991, which is equally unreliable. Gibbons used statistical modelling, and he has published many highly unreliable studies claiming that antidepressants protect against suicide. Several researchers have demonstrated that his studies are so dishonest that it is not a question of errors, but of deliberate cheating. Gibbons has been an expert witness in lawsuits for two pharmaceutical companies that sell antidepressants.

Number four was an article from Psykiatrisk Tidsskrift, an industry-funded throw-away magazine, entitled “Antidepressants increase risk factors for suicide,” and with the subheading, “A new Cochrane study shows that antidepressants increase the risk of mental health problems that can lead to suicide and violence.” My research group had reviewed the placebo-controlled trials of adult healthy volunteers. We found that antidepressants double the risk (risk ratio 1.9) of adverse effects that the FDA has determined increase the risk of suicide and violence. This was erroneously stated in the article as a risk of 15.2% versus 10.3% (giving a risk ratio of only 1.5). These figures are plucked out of thin air. They do not appear in our article at all.

Number five was an agreed wording for all antidepressants from the Danish Medicines Agency about the text in the package inserts: “Since an improvement in the depression may not be seen until after several weeks of treatment, the patient should be followed closely until an improvement is seen. General clinical experience shows that the risk of suicide may increase in the early stages of recovery.” One gets the impression that the risk of suicide may increase before the medication has had any effect.

The Danish Medicines Agency thus claims that antidepressants reduce the risk of suicide, which is deeply irresponsible. Furthermore, “general clinical experience” is unreliable. The Agency should have said that the placebo-controlled trials show that the risk of suicide is increased, not just at the start of treatment, but at any time, and especially with dose changes.

Number six was an article in Ugeskrift for Læger (Journal of the Danish Medical Association) by psychiatrist, PhD, Marianne Breds Geoffroy, with the title, “Youth suicide and antidepressants” and the subtitle, “Peter Gøtzsche claims that antidepressants have driven young people to suicide. But how can he know that?” It’s very simple. One of the strongest risk factors for suicide is previous suicide attempts, so when the medication increases the risk of suicide, some people will surely succeed. Psychiatrist David Healy and I have described many of these cases. Geoffroy begins her article with: “Peter Gøtzsche writes that it is antidepressants that have ‘driven young people to suicide.’ If that is correct, then why are not all children and young people who have depression and are given antidepressants driven to suicide?” Well, even if some die in traffic, we don’t all die. Geoffroy had received fees from Lundbeck, Eli Lilly and Novartis, all of which sell antidepressants.

Number seven was a mention in Ugeskrift for Læger of psychiatrist Lars Søndergaard’s PhD thesis. It was based on Danish registries, and Søndergaard found that there was “a reduced risk of suicide associated with continued treatment for all groups of antidepressants,” exactly the opposite of what the randomised trials have shown.

Number eight was my comment on the National Board of Health’s website. Professor of psychiatry Poul Videbech had claimed in the Board’s journal, Rational Pharmacotherapy, that undertreatment with antidepressants is dangerous because of the risk of suicide. I pointed out that this cannot be the case because antidepressants increase the risk of suicide. I wrote to the Board that Videbech was wrong on several other points and asked them to publish my comment in the journal, because announcements from the National Board of Health are given great weight. The Board replied that they do not have a debate forum in the journal and normally do not publish comments, but in this case, they made an exception.

Number nine was a mention on videnskab.dk (science.dk) of my research group’s meta-analysis of clinical study reports Eli Lilly had submitted to the European Medicines Agency. We demonstrated that duloxetine increases the risk of suicide and violence 4-5 times in middle-aged women with urinary incontinence compared to those given placebo. Later, the FDA announced that during the follow-up phase of these trials, there were 2.6 times as many women who attempted suicide than among other women of the same age.

Number ten was my article in Jyllands-Posten, a national newspaper, from 3 February 2018, “Another tragic suicide on depression pills.” The parents of Rasmus Burchardt had contacted me after their son had hanged himself in their bathroom 18 days after his doctor had prescribed mirtazapine for sleep problems and school fatigue. They had not been warned that depression pills can cause suicide and wanted me to write an article about it to warn others. They didn’t even know that Rasmus had been given a depression pill. Among other things, I wrote in Jyllands-Posten:

“This tragic story is unfortunately quite typical of suicides caused by depression pills. They often come without warning and the method is usually very violent, e.g. hanging, shooting or jumping out in front of a train, which guarantees that the attempted suicide attempt succeeds, as opposed to the more common approach of taking an overdose of pills, which is often a cry for help.”

“Many of these suicides never come to the attention of the authorities because it is a widespread but erroneous belief that depression pills protect against suicide. Therefore, many suicides are never reported. The pharmaceutical companies have also hidden many suicides and suicide attempts in their clinical trials. In fact, this is so widespread that it is justified to call it a research fraud with deadly consequences.”

“I agree with the parents that the authorities are not living up to the responsibility they have towards the public. Neither do the psychiatrists. Professor and psychiatrist Lars Kessing claimed in the ‘Evening Show’ on 15 April 2013 that antidepressants protect against suicide.”

My article created debate. Psychiatrist Poul Erik Buchholtz from Risskov claimed (JP 15 Feb) that depression pills prevent suicide among severely depressed patients, but there is no evidence for this. Buchholtz also believed that psychotherapy as the only treatment for severe depression is an impossibility. That is also wrong. My research group demonstrated in a 2017 meta-analysis that psychotherapy for patients who have attempted suicide halves the risk of another suicide attempt. Severely depressed patients should therefore get psychotherapy, not pills.

The denial was total. In Jyllands-Posten’s journalistic coverage of my article (JP 3 Feb), child and adolescent psychiatrist Professor Per Hove Thomsen also led the readers astray in his defense of the pills. He found it thought-provoking that in a period when the consumption of happy pills increased in Denmark, the number of suicides fell from around 1,500 to 700. Such data cannot be used for anything. Decreases or increases in suicides have many reasons, and in the USA (and in several other countries) suicides increased significantly in the same period when the consumption of happy pills also increased significantly, but the psychiatrists never say anything about this.

In the journalistic coverage, the chairman of the Danish Society for Family Medicine, Anders Beich, said that the long waiting list for psychiatrists can be disastrous, because it is dangerous to have depression, which in itself can lead to suicide. What is dangerous is that doctors change the reality and tell the public that depression pills prevent suicide.

Videbech also appeared. He wrote in an article (JP 10 Feb) that for children and young people there was possibly a “slightly increased risk of suicidal thoughts and behaviour, but not of completed suicides.” The analysis, Videbech referred to, found a doubling of the suicide risk in children and young people. This cannot be called a “possibly slightly increased risk.”

Videbech referred to a study by Kessing and colleagues, financed by the Lundbeck Foundation. Kessing was on Lundbeck’s payroll, and he found that in children and adolescents, “Those treated with SSRIs had a highly statistically significant and strongly increased rate of suicide compared to those not treated with SSRIs” (rate ratio of 19). But he concluded the opposite: “not treating severely depressed children and adolescents with SSRIs may be inappropriate or even fatal.” The authors presented another analysis in which they had adjusted for psychiatric hospital contact. The rate ratio was still increased, 4.47, but it was “no longer quite significant.” As mentioned, it is completely wrong to adjust for psychiatric hospital contact. Such contact increases the risk of suicide among psychiatric patients 44 times. The correction removed a true association between SSRIs and suicide.

With reference to Kessing’s misleading study, Videbech (JP 10 Feb) believed that many suicides among children and young people could have been avoided if treatment with antidepressant medication had been more widespread.

Psychiatrists have failed their responsibility towards the public to a catastrophic extent by claiming that depression pills protect against suicide when they do the opposite. I do not know of any other medical specialty whose practitioners systematically misinform the public to this extent.

Textbooks of psychiatry used by students of medicine, psychology and psychiatry contain a litany of misleading and erroneous statements about the causes of mental health disorders, if they are genetic, if they can be detected in a brain scan, if they are caused by a chemical imbalance, if psychiatric diagnoses are reliable, and what the benefits and harms are of psychiatric drugs and electroshocks. Much of what is claimed amounts to scientific dishonesty, and the textbook authors often cite research that is plagued with fraud or serious manipulations with the data.

The post The Lie That Antidepressants Protect Against Suicide Is Deadly appeared first on Mad In America.

It is important to know how a tapering process should be carried out. Unfortunately, very few doctors know that the binding curves of psychiatric drugs to brain receptors are hyperbolic in shape. Here is one for citalopram, a depression drug:

To reduce the risk of withdrawal symptoms, it is necessary to respect the form of the binding curve. It is therefore clearly wrong to reduce the dose by halving it from step to step, which most doctors do.

When doctors halve the dose, it might go well the first time when the dose is halved from 100% to 50%. This is because the vast majority of patients are overdosed and are therefore still high up on the binding curve for psychiatric drugs when they come down to 50%. According to the FDA’s package insert, citalopram should be administered at an initial dose of 20 mg once daily, generally with an increase to a dose of 40 mg/day. Thus, by halving the dose from 40 mg to 20 mg, very little happens. In both cases, about 80% of the receptors are occupied.

But already the next time, when the patients go from 50% of the starting dose to 25%, it can go wrong. For example, in a patient who is on 20 mg/day of citalopram, a reduction from a full dose to a quarter of this dose means that receptor occupancy goes down from 80% to 60%. If there are no withdrawal symptoms this time, they will usually come when you take the next step and come down to 12.5% of the starting dose (corresponding to 40% receptor occupancy). It is also way too fast for many patients to change the dose every two weeks, which many guidelines recommend.

The physical dependence on the pills is often so pronounced that it takes many months, in some cases years, to fully recover from them. One of the worst withdrawal symptoms is extreme restlessness (akathisia), which predisposes to suicide and violence, and in rare cases homicide.

The shape of the binding curve is respected if a certain percentage of the previous dose is removed. If you start by removing 10% of the dose, you come down to 90% of the starting dose, and if you are down to 50%, you should not reduce to 25% but only to 45%. These principles have been known for decades and were meticulously described in 2019 by Horowitz and Taylor (the article is behind a paywall).

Psychiatric drugs are not sold in the low doses that are necessary for a successful withdrawal. But there are several methods one can use to produce low doses. On the frontpage of my website, Deadly Medicines & Organised Crime, there are links to instructions about how to do this. There is also a list of people who are willing to help patients withdraw, no matter where they live, because ongoing help can be provided via the Internet. Such help is strongly recommended. And there are “A practical guide to slow psychiatric drug withdrawal” and “Tips and tricks”, which is about producing small enough doses, e.g. by using a nail file and a scale for tablets, counting beads in certain types of capsules, or dissolving capsule content in water.

My book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs, describes this in detail. It is available for free in a serialised version on the Mad in America website and also available for free in Spanish, French and Portuguese on my website Institute for Scientific Freedom. In addition, it has been published in Danish, Dutch, Italian, and Swedish.

If you are a patient, then be prepared that many doctors say it is impossible to experience withdrawal symptoms when lowering a dose far below the smallest dose that is commercially available. This only demonstrates their ignorance about basic principles of clinical pharmacology.

Another method for acquiring very small doses is to use tapering strips, which doctors from any country can order from the Regenboog Apotheek in Amsterdam, a GMP-compliant compounding pharmacy.

On the website www.taperingstrip.com (available in multiple languages), everything is explained and standardised forms for individual drugs can be downloaded. The only thing the doctor needs to do is:

1. Fill in the patient’s data (as for a regular prescription) and address for delivery
2. Fill in the doctor’s own data (for verification that it’s a valid prescription)
3. Fill in the start- and end-dose (enabling the pharmacy to make a leaflet with the daily doses)

Doctors who have doubts about how to fill in the form, or have other questions, are welcome to call  Paul Harder at +31 625 072 020 or email pharder@regenboogapotheek.nl.

The website was founded by Peter Groot and Jim van Os and the principle was developed by the User Research Centre of the Brain Department of the University Medical Centre of Utrecht.

The website informs doctors and patients about tapering the medication by gradually reducing the daily dose, thereby preventing or minimising withdrawal symptoms. Via the patients, the pharmacy receives useful feedback on how the tapering trajectory went, which can help improve the tapering schemes.

Several scientific studies have been published (freely available) based on information derived from the patients:

Groot PC, van Os J. Successful use of tapering strips for hyperbolic reduction of antidepressant dose – a cohort study. Ther Adv Psychopharmacol 2021; Aug 27.

Groot PC, van Os J. Outcome of Antidepressant Drug Discontinuation with Taperingstrips after 1-5 Years. Ther Adv Psychopharmacol 2020;10:2045125320954609.

Groot PC, van Os J. Antidepressant tapering strips to help people come off medication more safely. Psychosis 2018;10:142-5.

van Os J, Groot PC. Outcomes of hyperbolic tapering of antidepressants. Ther Adv Psychopharmacol 2023; May 9;13:20451253231171518.

The post Withdrawing From Psychiatric Drugs: How to Produce Smaller Doses Than Those the Drug Companies Provide appeared first on Mad In America.

Final words about a specialty in ruins and what to do about it

Among the authors of the five textbooks count some of the most prominent professors of psychiatry in Denmark. There is no reason to believe that the systematic betrayal of public trust would be any different in other countries. We see the same lies, denial and misleading information about psychiatry everywhere,⁷ as illustrated so convincingly in Whitaker’s review of Insel’s book.

Those who shape psychiatry are often deeply corrupt,^7,533 and they often “forget” to declare their conflicts of interest against the rules.⁷ These people are highly effective drug pushers. Court documents revealed that, in 1999, two such US psychiatrists, Charles Nemeroff and Alan Schatzberg, published a psychiatry textbook that was ghostwritten by GlaxoSmithKline.³³⁵

In 2000, they co-authored a report of a depression pill trial in New England Journal of Medicine where the authors had so many ties to drug companies that there wasn’t room for them in the print journal (they took up 1067 words).⁶⁹³ This made the journal’s editor, Marcia Angell, publish an accompanying editorial: “Is academic medicine for sale?”⁶⁹⁴ She explained that it had been difficult to find a psychiatrist to write an editorial who was not conflicted. This showed that the whole specialty has been corrupted by industry money. Nemeroff and Schatzberg declared 17 industry ties each:

Dr. Nemeroff has been a consultant to or received honoraria from Abbott, AstraZeneca, Bristol-Myers Squibb, Forest Laboratories, Janssen, Eli Lilly, Merck, Mitsubishi, Neurocrine Biosciences, Organon, Otsuka, Pfizer, Pharmacia–Upjohn, Sanofi, SmithKline Beecham, Solvay, and Wyeth–Ayerst. He has received research support from Abbott, AstraZeneca, Bristol-Myers Squibb, Forest Laboratories, Janssen, Eli Lilly, Organon, Pfizer, Pharmacia–Upjohn, SmithKline Beecham, Solvay, and Wyeth–Ayerst.

Dr. Schatzberg has served as a consultant to or received honoraria from Abbott, Bristol-Myers Squibb, Corcept Therapeutics, Forest Laboratories, Janssen, Eli Lilly, Merck, Mitsubishi Pharmaceuticals, Organon, ParkeDavis, Pfizer, Pharmacia–Upjohn, Sanofi, Scirex, SmithKline Beecham, Solvay, and Wyeth–Ayerst. He has received research support from BristolMyers Squibb, Pfizer, and SmithKline Beecham. He has equity ownership in Corcept, Merck, Pfizer, and Scirex.

I wonder if such people have time for seeing patients, or for listening to those they see.

The many erroneous and misleading statements I found cannot be explained by the advent of new, important knowledge, as the publication dates for the textbooks were recent, from 2016 to 2021. Furthermore, even though I have sometimes used recent articles to demonstrate that the authors are wrong, the knowledge I convey has existed for many years prior to 2016.

In the protocol for my study, I noted that the textbooks should mention that the causes of psychiatric disorders are mainly environmental, and not genetic or related to a visible brain abnormality. The textbooks conveyed the opposite message, and strongly so, although there is no foundation for a biological model of psychiatric disorders. The psychiatrists have not even been able to explain what exactly they mean by this.⁹

I also noted in my protocol that there are no reliable trials that have shown that drugs are better than placebo for overall functioning, quality of life, return to work, sick leave, and social relationships. The textbooks were remarkably silent on this important issue, even though there is clear evidence, particularly from non-industry funded randomised trials and from good observational studies, that long-term drug treatment is harmful.^1,5

It was disappointing that psychologists mostly said the same as the psychiatrists, and they were sometimes even more radical and uncritical than them, e.g. in their praise of the imaging studies and the drugs. I think there are two reasons for this. In a radicalised group, newcomers tend to be even more radical than their leaders to become accepted as their equals. Therefore, fringe groups tend to become more radical with time. The other reason is related to the first one. Some psychologists want to get permission to prescribe drugs and their scientific associations often support this idea. They will not succeed if they are seen as critics of mainstream psychiatry.

One of the textbooks, Clinical Neuropsychology, which has three psychologists as editors, exemplifies this issue.²⁰ It has three full pages describing imaging studies in depression, with many references.^20:432 It conveys the impression to the students that we know a lot about the brain based on reliable studies, which is totally false. Students believe what they read in their university books of psychiatry, even though it can best be characterised as brainwashing, and they may spread their false ideas even more forcefully when confronted with irrefutable evidence to the contrary.¹⁴

Many psychologists do not realise that they have a great advantage over psychiatrists, which is that they are educated with the aim of understanding the patients where they are and helping them with psychotherapy and other forms of support. It is very sad when psychologists buy into the false narrative the psychiatrists and the drug industry have created about their drugs instead of criticising it. If we lose the leading psychologists, there is little hope for the patients who would then need to consult therapists with lesser educations. Some of them are very good, but they do not have an academic background for understanding the science.

When I announced in the Critical Psychiatry Network that I was writing a critical textbook of psychiatry that would explain what was wrong with the current textbooks, a general practitioner reported what she experienced when she went to a regional meeting about adult ADHD three years earlier to learn something. Here is what she learned:

The psychiatrist that lectured was in the pay of three drug companies. He presented no peer reviewed research and said he didn’t like rules; he just knew what worked. The audience wasn’t allowed to ask him direct questions. We were put in groups to discuss how we should implement what we had heard. Members of my group were stunned when I was chastised for asking two questions, one about how conflicts of interests might interfere with good prescribing and the other about the lack of long-term studies. I was told I was a dinosaur and too old to be flexible and innovative and go with modern medicine developments. I’ve never experienced anything like this before! I confronted the bully face to face when the group work was finished and left him with a stern reminder to keep his mind open.

Whether drugs are legal or illegal, it is unhealthy to perturb brain functions with them. Brain-active substances can lead to violence, including murder. An analysis of adverse drug events submitted to the FDA between 2004 and 2009 identified 1,937 cases of violence, 387 of which were homicide.⁴⁰¹

The violence was particularly often reported for psychotropic drugs—depression pills, sedatives/hypnotics like benzodiazepines, ADHD drugs and a smoking cessation drug that also affects brain functions. Depression pills are being suspected of having a causal role in mass shootings, but when one of the teenage shooters in the Columbine High School massacre was found to have taken a depression pill, the American Psychiatric Association denounced the notion that there could be a causal relation and added that undiagnosed and untreated mental illness exacts a heavy toll on those who suffer from these disorders as well as those around them.⁶⁹⁵

This is sickening. It is marketing speak and standard industry tactic to blame the disease and not the drug, but this is what psychiatrists do all the time. The other murderer had taken both sertraline and paroxetine.

Drugs and guns are a dangerous cocktail, but America abounds in both, including easy access to opioids on prescription, which makes this country the most backward in the Western world.

There are many other high-profile cases where the mass murderers were on depression pills,⁶⁹⁶ but in many cases, information about the shooters’ prescription drug use and other medical history has been kept from public records. Drugs causing homicide is taboo.

The hypocrisy is all over the place. As an example, universities are happy to accept enormous gifts from industry at the same time as they implement stringent conflict of interest policies for their faculty and their relationship with commercial sponsors.⁶⁹⁷

One of the chapters in my book about organised crime in the drug industry was “Psychiatry, the Drug Industry’s Paradise”.⁶ Psychiatry is second to none in exploiting people with harmful drugs and in killing, incapacitating or maiming hundreds of millions of people. In 1990-92, 12% of the US population aged 18–54 years received treatment for emotional problems, which went up to 20% in 2001–2003.⁶⁹⁸ Although there are hundreds of diagnoses in DSM-IV, and even more in DSM-5, only half of people who were in treatment met diagnostic criteria for a disorder. In 2012, the US Centers for Disease Control reported that 25% of Americans have a mental illness.⁶⁹⁹

We must put an end to this insanity in a profession that is supposed to take care of the insane. We have a chance of influencing those who study psychiatry before it is too late and they have accepted the false narrative. This was my motivation for writing this book.

As child and adolescent psychiatrist Sami Timimi explains, psychiatry ignores much of the genuine science there is and instead goes on supporting and perpetuating concepts and treatments that have little scientific support.^10:20 He calls this “scientism”. It means that psychiatry likes to talk in the language of science and treats this as more important than the actual science.

In Timimi’s debates with fellow psychiatrists about the evidence, three defences are common. The first is the use of anecdote—such and such a patient got better with such and such a treatment, therefore, this treatment works. The second is an appeal about taking a “balanced” perspective. But each person’s idea of what a balanced position is depends on where they are sitting. We get our ideas on what is balanced from what is culturally dominant, not from what the science tells us. The third is that when molecular genetics has consistently failed to produce anything about diagnoses being related to specific genes, we are told that the area is “complex.”^10:63 This is bullshit.

When I published my 10 myths about psychiatry, which are harmful for people, in a major newspaper in January 2014, I ended my article this way:¹⁸⁹

Psychotropic drugs can be useful sometimes for some patients, particularly in short-term use, in acute situations. But after my studies in this area, I have arrived at a very uncomfortable conclusion: Our citizens would be far better off if we removed all the psychotropic drugs from the market, as doctors are unable to handle them. It is inescapable that their availability causes more harm than good. The doctors cannot handle the paradox that drugs that can be useful in short-term treatment are very harmful when used for years and create those diseases they were meant to alleviate and even worse diseases. In the coming years, psychiatry should therefore do every-thing it can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs.

My article caused an outcry that lasted for a couple of months, spearheaded by the drug industry and their paid allies among doctors and journalist friends. I got the whole Danish establishment on my back, and the Minister of Health threatened that I could get fired.^7:278 The only thing I had done was to tell people the truth. But this cannot be tolerated when the subject is psychiatry.

Outside the power circles, my paper was much appreciated.⁷⁰⁰ Numerous articles followed, some written by psychiatrists who agreed with me. For more than a month, there wasn’t a single day without discussion of these issues on radio, TV or in newspapers, and there were also debates at psychiatric departments. People in Norway and Sweden thanked me for having started a discussion that was impossible to have in their country, and I received hundreds of emails from patients who confirmed with their own stories that what I had written was true.

Nothing changed, however. Perhaps a little here and there, but nothing material. On the other hand, it matters for some people that we protest. Many patients and relatives have told me that my books have saved lives, as they gave the patients the courage to withdraw from their drugs against their doctor’s advice.^8:167 These emails documented a high level of ignorance and arrogance among psychiatrists and here is a typical example:

Her psychiatrist told her she had an incurable genetic disease and needed psychosis pills for the rest of her life. When she complained that she could no longer concentrate, slept a lot and believed the drugs affected her memory, making it hard to study, the reply was that the problem wasn’t the drugs but that she lost neurons due to the psychosis and that her brain wasn’t the same anymore. So, she needed to take psychosis pills indefinitely to protect her brain from losing more neurons; otherwise she would become demented. When she had withdrawn the drugs despite this advice, she was told she would have a new psychotic episode. When she said she didn’t want to take the drugs for the rest of her life, her psychiatrist replied that she would then not see her anymore because she only worked with patients who wanted to be treated.

What should be do about this? I have these suggestions:^8:172

1. Leave mental health issues to psychologists and other caring professions. They are not medical diseases. Consider involving recovery mentors who have lived experience.
2. Psychiatry as a medical specialty should be disbanded. In evidence-based healthcare, we do not use interventions that do more harm than good, which psychiatry does. Let psychologists who are against using psychiatric drugs be heads of psychiatric departments and give them the responsibility for the patients.
3. Psychiatrists should be re-educated so that they can function as psychologists. Those who are not willing to do this should find themselves another job.
4. The focus should be on getting patients off psychiatric drugs, and to avoid starting them. Never start a drug without having a tapering plan.
5. Establish a 24-hour national helpline and associated website to provide advice and support for those adversely affected by prescribed drug dependence and withdrawal.
6. Provide tapering strips and other aids at no cost to help patients withdraw from their drugs. This would lead to huge savings for society.
7. Apologize. It means a lot for victims of abuse to get an apology.
8. Change psychiatry’s misleading narrative, which starts with the semantics. Speak about depression pills, psychosis pills, speed on prescription, etc. Stop using words such as psychiatry, psychiatrist, psychiatric disorder, psychiatric treatments, and psychiatric drugs, as they are stigmatising and as patients and the general public associate them with bad outcomes. Talk about mental health instead.
9. Discard the psychiatric diagnosis systems entirely and focus on the patients’ problems.
10. Drop the rating scales, both in research and practice, and focus on recovery, i.e. a return to a normal productive life.
11. Make forced treatment unlawful.
12. Make psychiatric drugs available only for use under strictly controlled circumstances:
13. a) while patients are tapering off them; or
    b) in rare cases where it is impossible to taper off them because they have caused permanent brain damage; or
    c) in patients with alcoholic delirium, as sedatives under operations and other invasive procedures, e.g. colonoscopy, and in other circumstances to be defined.
14. Make it unlawful to use drugs that are registered for nonpsychiatric uses, e.g. anti-epileptics, for mental health issues.
15. Avoid financial conflicts of interest with manufacturers of psychoactive drugs or other treatments, e.g. equipment for electroshock.
16. Forbid all rules about demanding a psychiatric diagnosis to get social benefits, or extra economic support to schools.
17. Make it illegal for general practitioners to prescribe psychiatric drugs, which they cannot handle. In relation to depression, the chairman for the Danish Association for General Practitioners said in 2014 that they didn’t have “oceans of time” and couldn’t set aside a whole hour for one patient, as they also needed to think of their economy.⁷⁰¹ They therefore hand out depression pills liberally. A US study showed that over half of the physicians wrote prescriptions after discussing depression with patients for three minutes or less.¹⁷²
18. Tell the patients that it is rarely a good idea to see a family doctor or a psychiatrist if they have a mental health issue. There is a huge risk that they will be harmed.

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Six) appeared first on Mad In America.

After psychosis pills were introduced in the mid-1950s, clinicians began speaking about the “revolving door syndrome” that now appeared in asylum medicine. First-episode patients would be discharged and then return in droves, which led the NIMH, during the 1970s, to fund four studies to assess whether psychosis pills were increasing the chronicity of psychotic disorders.

Bockoven⁶⁵² reported that the rehospitalisation rate for discharged patients was higher for patients treated after the arrival of psychosis pills and the medicated patients were also more “socially dependent” than those treated before 1955. Carpenter,⁶⁵³ Mosher,⁶⁵⁴ and Rappaport⁶⁵⁵ reported superior outcomes for unmedicated patients after 1-3 years, which led Carpenter to “raise the possibility that antipsychotic medication may make some schizophrenic patients more vulnerable to future relapse than would be the case in the natural course of the illness.”

By this time, researchers were fleshing out the adaptive brain changes stirred by psychosis pills. Chouinard concluded that drug-induced dopamine supersensitivity “leads to both dyskinetic and psychotic symptoms. An implication is that the tendency toward psychotic relapse in a patient who has developed such a supersensitivity is determined by more than just the normal course of the illness.”⁶⁵⁶ This understanding of how the brain adapts to psychosis drugs provided a biological explanation for why drug treatment increased the chronicity of psychotic disorders and a causal explanation for the findings reported by Bockoven, Carpenter, Mosher and Rappaport.

Nancy Andreasen, also funded by NIMH, reported in a large MRI study of patients with schizophrenia that psychosis pills shrink brain volumes over time,⁶³ and that this shrinkage is associated with a worsening of negative symptoms, increased functional impairment, and, after five years, cognitive decline.⁶⁵⁷

In the late 1970s, with funding from the NIMH, Martin Harrow and Thomas Jobe launched a long-term study of 200 patients diagnosed with schizophrenia or other psychotic disorders, most of whom were experiencing a first or second episode of psychosis. They found that the outcomes of those who got off their psychosis pills by year two began to dramatically diverge from those who stayed on the drugs, and that at the end of 15 years, the recovery rate for the off-med patients was eight times higher than for the medication compliant patients (40% versus 5%).⁶⁵⁸ They also reported that the medication compliant patients were much more likely to remain psychotic over the long term than those who got off the medication, and it was the off-medication patients who had dropped out of treatment that had the better outcomes.⁶⁵⁹ They referred to drug-induced dopamine supersensitivity as a likely reason for this difference in outcomes.

In the past two decades, longer term studies of psychotic patients conducted in the Nether-lands (the only long-term randomised trial of drug discontinuation, see Chapter 7, Part Four),¹⁹² Finland,⁶⁶⁰ Australia,⁶⁶¹ Denmark,⁶⁶² and Germany⁶⁶³ all told of higher recovery rates for those off drugs. Similarly, users of psychosis pills tell of how these drugs compromise functional recovery over the long-term.⁶⁶⁴

The history of depression pills is much the same. Prior to their introduction, depression—and this finding came from studies of hospitalised patients—was understood to be an episodic disorder. Patients could be expected to recover, and around half of the patients who suffered a first episode would never be rehospitalised for depression.

After the introduction of depression pills, some clinicians observed a “chronification” of the depression. In the 1980s, several studies found high relapse rates in patients treated with depression pills, and an expert panel convened by the NIMH concluded that, in contrast to older studies of mood disorders, “new epidemiological studies [have] demonstrated the recurrent and chronic nature of these illnesses.”⁶⁶⁵ The elephant in the room was ignored.

Two NIMH studies in real-world patients treated in outpatient settings confirmed that this was the long-term course for medicated patients. The STAR*D trial,⁶⁴⁷ with its 3% stay-well rate at the end of the one-year follow-up on depression pills stood in sharp contrast to another NIMH funded trial that sought to identify the long-term outcome of untreated depression in recent times. In that study, 85% of the included 84 patients had recovered by the end of one year.⁶⁶⁶ The researchers concluded that “If as many as 85% of depressed individuals who go without somatic treatment spontaneously recover within one year, it would be extremely difficult for any intervention to demonstrate a superior result to this.”

Many studies over the past 35 years have compared outcomes for medicated and unmedicated patients over longer periods of time.

In an NIMH study that randomised 250 patients to imipramine or to two forms of psychotherapy or to placebo, the stay-well rate was highest for cognitive therapy (30%) and lowest for imipramine (19%) and placebo (20%) after 18 months.⁶⁶⁷

In an NIMH study of 547 patients that compared six-year outcomes for depressed people treated for the disorder and those who eschewed medical treatment, the treated patients were three times more likely than untreated ones to suffer a cessation of their principal social role and nearly seven times more likely to become incapacitated.⁶⁶⁸

A WHO study of 640 depressed patients found that those treated with medication had worse general health and were more likely to still be mentally ill than those who weren’t treated at the end of one year.⁶⁶⁹

A Canadian study of 1,281 people who went on short-term disability due to a depressive episode found that 19% of those who took a depression pill went on to long-term disability compared to 9% of those who never took such medication.⁶⁷⁰

In a five-year study of 9,508 depressed patients in Canada, medicated patients were depressed on average 19 weeks a year, versus 11 weeks for those not taking drugs.⁶⁷¹

Two reviews of the long-term outcomes of patients diagnosed with depression found that use of a depression pill was associated with worse outcomes at nine years⁶⁷² and at 30 years.⁶⁷³

As these findings have piled up, researchers—led by Italian psychiatrist Giovanni Fava—have pointed to drug changes induced by depression pills as a likely explanation for the “bleak long-term outcome of depression … use of antidepressant drugs may propel the illness to a more malignant and treatment unresponsive course.”^674-677

In a 2011 paper, American psychiatrist Rif El-Mallakh observed that 40% of depressed patients initially treated with a depression pill were now ending up in a chronically depressed “treatment resistant” state.⁶⁷⁸ He wrote that continued drug treatment may induce processes that may “cause a worsening of the illness, continue for a period of time after discontinuation of the medication, and may not be reversible.”

Given this literature, it is no surprise that depression is now the leading cause of disability in the United States for people ages 15 to 44, and that in country after country that has adopted widespread use of SSRIs, the number of people on government disability due to a mood disorder has increased in lockstep with the increased use of these drugs.^119:24

Whitaker also mentioned the MTA trial (see Chapter 9, Part Two). The investigators noted that, at the end of three years, being on a stimulant was a significant marker not of beneficial outcome, but of deterioration.⁵¹⁷ At the end of six to eight years, the results were much the same.⁵²¹ Longer-term ADHD studies in Australia⁶⁷⁹ and Quebec⁶⁸⁰ also found worse outcomes for medicated youth than for those treated without stimulants.

As Whitaker noted, the research literature shows that psychosis pills and depression pills increase the chronicity of the disorders, and the same is true for stimulants, benzodiazepines, and drugs used for bipolar disorder. He also mentioned that a longer list of over 100 papers that tell of these outcomes can be found on the Mad in America resource pages for psychosis pills, depression pills, benzodiazepines, polypharmacy for bipolar disorder, and stimulants.⁶⁵⁰

None of this history is found in Insel’s book or on NIMH’s website.⁶⁵⁰ A search for Martin Harrow shows nothing even though he was considered one of NIMH’s experts on schizophrenia. A search for STAR*D shows the press release about the short-term results that tells of “particularly good results” with depression pills that “highlight the effectiveness of high-quality care.”⁶⁸¹ The one-year stay-well rate for patients treated with depression pills of 3% is missing (that information was hidden in the journal article that reported one-year outcomes⁶⁴⁸). And the NIMH website information about ADHD⁶⁸² does not inform parents that in the MTA study, medication use was a marker of deterioration by the end of year three, and that those taking stimulants had worse ADHD symptoms and were more functionally impaired at the end of six years.

The chemical imbalance myth is derided as a hypothesis that fell out of favour⁹⁷ decades ago, with Ronald Pies, former editor in chief of Psychiatric Times, describing it as an “urban legend” that was never “seriously propounded by well-informed psychiatrists.”⁹⁷ Allen Frances,⁶⁸³ and other prominent figures in the field, including Insel⁶⁸⁴ and his predecessor Steven Hyman,⁶⁸⁵ acknowledge that the disorders in the DSM manual have never been validated as discrete illnesses, and that the diagnostic categories are constructs. In his book, Insel admits that the so-called second-generation psychiatric drugs are no better than the first, the notion that they were “breakthrough medications” having been put to rest some time ago.

In 2015, Whitaker and Lisa Cosgrove published Psychiatry Under the Influence,⁵⁹⁹ a book that arose from their time as fellows at the Safra Center for Ethics at Harvard University, in a lab devoted to studying institutional corruption. In a democratic society, the expectation is that institutions that serve a public interest—and this is particularly true for medical disciplines—will adhere to ethical standards. This includes rising above financial influences; being objective in their design of studies and their analysis of the data; reporting the results in an accurate and balanced way; and putting the interests of patients first.

In a 2009 essay,⁶⁸⁶ Daniel Wikler, a professor of ethics at the Harvard School of Public Health, wrote that a medical discipline that fails to adhere to this standard doesn’t deserve to retain its privileged place in society.

On Whitaker’s Mad in America website there are two more reviews of Insel’s book.⁶⁵⁰ These reviews also describe how the book functions as a work of propaganda for a sick system.

The erosion of medical integrity is complete for psychiatry^1-11,533 and the psychiatric narrative has collapsed. Yet, drug prescribing increases. If the psychiatric profession told the public the truth, psychiatry would have to completely reorganise its care.

As Whitaker wrote,⁶⁵⁰ this is the bridge that psychiatry, as a guild, cannot cross. The profession needs to keep the truth out of sight, even to itself, and it is not presented in psychiatric textbooks or in continuing medical education seminars. By keeping the history hidden, the field is breaking its compact with the public and itself—with every prescriber and all those who enter the field.

A 2022 misleading seminar in The Lancet about suicide 

A recent Lancet seminar was yet another proof that psychiatry has degenerated to a point from which there is no return. Honest information about suicide is of utmost importance but the article Lancet published, “Suicide and Self-harm,”⁶⁸⁷ was dishonest.

The seminar was very long, 14 pages, with 142 references. Many people consider Lancet a highly prestigious and influential journal, which should therefore be open to criticism and debate. But it isn’t. A journal that does not accept letters for publication unless they arrive within two weeks of publication of the original item and unless they are no longer than 250 words does not invite criticism and a sound scientific debate. Many people will not know that an article has been published before it is too late to criticise it.

The Lancet seminar is one of the most misleading articles about suicide I have ever seen.⁶⁸⁸ The authors wrote that research has identified “associations between suicidal behaviour and dysregulation of the hypothalamic–pituitary–adrenal axis and serotonergic neural transmission.”

They tried to resurrect the stone dead myth about a chemical imbalance in the brain being the cause of psychiatric disorders, and the two references they cited are untrustworthy (see Chapter 4). The first alluded to epigenetic modification of genes, alterations in key neurotransmitter systems, inflammatory changes, and glial dysfunction in the brain as causal factors. The second suggested hypothalamic-pituitary-adrenal axis dysfunction, which “in turn can be traced back to genetic predisposition” and “early life stress-related epigenetic mechanisms.”

Among risk factors for suicide, the authors mentioned “harmful substance use” but not depression pills, antiepileptics, or the psychiatric profession itself. These are taboos for suicide researchers.

The authors wrote that “The use of medication to prevent suicide is controversial” and that there is a “possibility of exacerbating suicidal thoughts, particularly in young people.”

As I have explained in my book, it is seriously dishonest to speak about a “possibility of exacerbating suicidal thoughts.” These drugs not only exacerbate suicidal thoughts, they cause them, and they also cause suicidal behaviour, suicide attempts, and suicide.

The seminar authors did not quote any of the many meta-analyses of placebo-controlled trials that showed that depression pills increase the suicide risk. Instead, they quoted a book written by the last author of the seminar and by Robert D Goldney who has published a fatally flawed review about depression pills and the risk of suicide.⁶⁸⁹

His paper is a classic example of how one should not do a review.^7:100 He cherry-picked those observational studies that supported his idea that depression pills protect against suicide, e.g. studies in the Nordic countries that linked prescribing of depression pills with a reduction of suicide, but these studies are untrustworthy.^7:97 Nordic researchers have shown that there is no statistical association between the increase in sales of SSRIs and the decline in suicide rates in the Nordic countries.⁶⁹⁰ They reported that the decline in suicides in Denmark and Sweden predated the introduction of SSRIs by 10 years or more.

The Nordic researchers had no conflicts of interest while Goldney had “received honoraria and research grants from a number of pharmaceutical companies.” With his flawed reviews, Goldney must be worth far more than his weight in gold for the drug industry.

The seminar authors wrote that “treatment of underlying psychiatric conditions through medication can reduce suicidal behaviour.” They gave no references to this information. Which are the miraculous drugs that can reduce suicides? All we know is that psychiatric drugs increase suicides.

A little later, they wrote: “Evidence from several studies, most of which were observational, suggests that antidepressants might reduce the risk of suicide.” They used the UFO trick. They quoted a 2021 review that reported that meta-analyses had found that “antidepressants prevent suicide attempts, but individual randomized controlled trials appear to be underpowered.”⁶⁹¹ These meta-analyses were of observational studies. All meta-analyses of randomised trials have shown the opposite and they are not underpowered.

In the next sentence, they wrote: “However, some research has found an association with increased risk of suicide-related outcomes in young people.” This is also blatantly false. When the FDA looked at all relevant research, not just some research, and indeed the best we have, the randomised placebo-controlled trials, it was a causal relation and not just an “association.”

In the ensuing sentence, they wrote: “The evidence base is far from complete, since many randomised trials exclude people at heightened risk of self-harm or suicide.” This is utter nonsense. We have all the data we need to conclude that depression pills double suicides. The authors used the familiar trick Schopenhauer calls diversion by suddenly talking of something else that has no bearing on the matter.

The authors claimed that “Lithium has been associated with reduced suicide rates in people with bipolar disorder and depression, which might be a specific effect not seen with other drugs designed to stabilise mood.” As noted earlier (see Chapter 8, Part Ten), there is no reliable evidence that lithium reduces suicides.

About the latest fad in psychiatry, the authors wrote that “Ketamine has shown promise.” It hasn’t (see Chapter 8, Part Three).

There was a glimpse of light in all the psychiatric darkness. The authors wrote that “cognitive behavioural therapy and related treatments have the strongest evidence base for reducing suicidal ideation and repeat self-harm compared with treatment as usual.”

This is correct, but they quoted a review that included self-harm. Self-harm does not always imply a suicidal intent. My research group therefore did a systematic review where we excluded self-harm studies. We found that psychotherapy halves the risk of a new suicide attempt in people acutely admitted after a suicide attempt.²⁷² Our review was published in 2017 in a well-known journal but was not among the seminar authors’ 142 references even though it sends a very strong message: Do not use pills but psychotherapy if you want to prevent suicide.

Lancet is not the source to go to if one wants reliable information about depression pills. It is the extended marketing arm of the pharmaceutical industry,⁶⁹² just like the New England Journal of Medicine is, also in relation to articles denying that depression pills cause suicide.³³⁷

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Five) appeared first on Mad In America.

The disappointing CATIE and STAR*D studies

The two sane authors of the first chapter of the 1065-page textbook noted that naturalistic studies—which they did not reference but mentioned by name, CATIE, STAR*D, and Storebø 2016—have shown smaller effects than those the drug companies have advertised.^17:57 They also said that psychiatry is plagued by a bad reputation after cases of overmedication and that more caution is needed when using psychiatric drugs.^17:58

For CATIE, there were 191 records on PubMed. It was an NIMH-financed trial, which randomised 1,493 “real-world” patients with schizophrenia to olanzapine, quetiapine, risperidone or ziprasidone, or to a very old drug, perphenazine, marketed in 1957.

The results must have agonised the key opinion leaders in psychiatry. The primary outcome was very reasonable, time to discontinuation for any reason, which reflects both the benefits and the harms of the drugs. After 18 months, only 26% of the patients were still on the randomised drug, and perphenazine was not worse than the “atypicals” and did not produce more extrapyramidal harms than these agents.²³⁹

So much for the highly praised “modern” psychosis pills, which are far more expensive than a 65-year-old drug off patent. But psychiatry’s narrative was not affected. The study authors talked about the comparable levels of effectiveness of the five drugs,²³⁹ but they should have talked about comparable levels of ineffectiveness, as all the drugs failed according to the primary outcome. Psychiatrists are masterminds in this type of semantic deception.

STAR*D was also financed by the NIMH. It is a remarkable story of fraud.^7:118 Like CATIE, it was a highly relevant study of real-world patients. With 4,041 included patients,⁶⁴⁷ it is the largest effectiveness study ever conducted of depression pills. The investigators announced that the study would produce results with “substantial public health and scientific significance,”⁶⁴⁷ which it did, but not in the way they had imagined.

There was no placebo group, and all patients started on citalopram, manufactured by Lundbeck, which was motivated by horrendously erroneous claims of citalopram’s “absence of discontinuation symptoms” and its “safety” in elderly patients. In their disclosure statements, 10 of STAR*D’s authors reported receiving money from Forest, Lundbeck’s partner in the United States.

When the study was over, NIMH announced falsely that “about 70% of those who did not withdraw from the study became symptom-free.” The investigators also made numerous false claims, e.g. that the patients who scored as remitted had “complete absence of depressive symptoms” and had “become symptom-free.” The truth was that a “remitted” patient could have a Hamilton score of 7. The only Hamilton suicide question, “feels like life is not worth living,” is scored as 1, and other symptoms that are scored as 1 include “feels he/she has let people down” and “feels incapable, listless, less efficient.” No honest professional would describe such patients as having become symptom-free.

The researchers noted in their abstract that, “The overall cumulative remission rate was 67%.” In the main text, however, they said that this was a “theoretical” remission rate assuming that those who exited the study would have had the same remission rates as those who stayed in the protocol. That assumption is extremely unlikely to be true. There are usually many more treatment failures among those who drop out than among those who continue.

The investigators cherry-picked the data they reported. This involved the Texas sharpshooter trick (see Chapter 6) by changing the measurement scale. They also included patients that, according to the protocol, should have been excluded. This, the French call “sauve qui peut” (save those you can), which characterises a state of panic or disorder.

The data were presented in such a confusing manner that it is extremely difficult to correct for all the errors and find out what really happened, even for a seasoned research detective like me. Ed Pigott et al. did the hard detective work for us.⁶⁴⁷ It turned out that only 3% of the patients who entered the trial remitted, stayed well, and stayed in the trial during the one-year follow-up!

This publicly funded study bombarded doctors and the public with the totally mendacious message that depression pills enable about 70% of depressed outpatients to recover. The medications were said to be “far more effective” than placebo, which was also mendacious, as there was no placebo group in the trial.

A journalist interviewed one of the STAR*D investigators, Maurizio Fava, a prominent psychiatrist, who acknowledged that the 3% success rate was accurate and that the investigators knew this all along.⁶⁴⁸

The many STAR*D papers display highly selective reporting of outcomes, numerous false claims, contradictory statements, and even pure fiction. As of mid-2011, despite over 100 papers having been published, 11 prespecified outcomes had still not been reported.¹⁴⁷ One paper stated in the abstract that suicidal ideation was seen in only 0.7% of the patients, and the authors said that their study “provides new evidence to suggest little to no relation between use of a selective serotonin reuptake inhibitor and self-reported suicidal ideation.” This statement was contradicted by some of the same authors who, in other papers, mentioned suicidal ideation in 6.3% and 8.6% of those on citalopram in STAR*D, i.e. 10 times more.

It is remarkable that suicidality can differ by a factor of 10 or more in different publications of the same trials, but this was also the case when the FDA investigated this issue (see Chapter 8, Part Six).

The STAR*D study is so fraudulent that all its 100+ papers should be retracted. Ed Pigott says about this:⁶⁴⁹

“In my five plus years investigating STAR*D, I have identified one scientific error after another. Each error I found reinforced my search for more … These errors are of many types, some quite significant and others more minor. But all these errors—without exception—had the effect of making the effectiveness of the antidepressant drugs look better than they were, and together these errors led to published reports that totally misled readers about the actual results. As such, this is a story of scientific fraud, with this fraud funded by the National Institute of Mental Health at a cost of $35 million.”

I could not find any naturalistic study published by Storebø in 2016. The textbook authors might have referred to his 2015 Cochrane review, which found that every single trial ever performed of stimulants in children with an ADHD diagnosis was at high risk of bias.⁵¹¹

Thomas Insel and the NIMH: A total betrayal of public trust

Thomas Insel, called “America’s psychiatrist,” was director of the NIMH for 13 years, till 2015.⁶⁵⁰ In 2022, he published the book, Healing: Our Path from Mental Illness to Mental Health.⁶⁵¹

The book makes an unintended case for abolishing psychiatry even though Insel tries to support it.⁶⁵⁰ He takes on the role of a drug salesman, and already the title is misleading. There has been no path from mental illness to mental health, only one to even more mental illness.

Insel is aware of this and promises to investigate why mental health outcomes in the United States are so poor. The publisher presents the book as a roadmap for change, but this is not what it is about; in fact, Insel shies away from suggesting what is so obviously needed.

Coming from the most prestigious institution in the world in mental health, it is worth looking more closely at this book, as it reflects the thinking of psychiatric leaders all over the world. This is what Robert Whitaker did in his book review.⁶⁵⁰ The book encapsulates how psychiatry has consistently betrayed public trust and misinformed the public. It underlines that psychiatry will never tell the public the truth about psychiatric drugs, and Whitaker concludes that the real source of the poor mental health outcomes in the United States is the psychiatric establishment, including the NIMH, which—although being a governmental agency—cannot be trusted.

Being a former NIMH director, Insel should have told his readers about the poor long-term outcomes of treatment with psychiatric drugs, as documented in expensive and prestigious research funded by the NIMH, e.g. CATIE and STAR*D. He didn’t, even though he had an obvious ethical obligation to do so.⁶⁵⁰ Whereas drug companies have funded the short-term studies of drugs, it was the NIMH, dating back to the 1970s, that funded studies of their long-term effects.

This made it even more deplorable that Insel avoided commenting on them. The public expects that a medical specialty will be an honest purveyor of scientific findings about the benefits and harms of its interventions, and if its research tells of treatments that worsen long-term outcomes, then the medical specialty will inform the public of those outcomes and rethink its practices.

For 65 years, psychiatry has failed to do this. Insel could have remedied this betrayal of public trust with this book and put psychiatry on a new path, but he sacrificed the patients and protected the psychiatric guild by keeping the long-term studies hidden.

When Whitaker wrote his book, Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, first published in 2010,⁵ he started out with a medical puzzle.

The conventional history of psychiatry tells of how the introduction of psychosis pills in 1954 kicked off a psychopharmacological revolution, which was said to take another step forward with the SSRIs in 1988. The prescribing of psychiatric drugs soared, but why did the burden of mental illness soar, too? According to Insel, the number of adults in USA receiving a social security payment due to a mental disorder rose from around 1.3 million in 1987 to around 6 million today.

Whitaker dug through the research literature, and with each class of drugs, he tried to find out what the clinical course was before and after the introduction of drugs, and if the medicated or unmedicated patients had better long-term outcomes in clinical studies. Whitaker found that psychosis pills, depression pills and benzodiazepines worsen long-term outcomes, and that bipolar disorder, which is regularly treated with polypharmacy, runs a much more chronic course than manic depressive disorder—the diagnostic precursor to bipolar—once did.⁵

Whitaker is a careful researcher and his book is highly convincing. There was a great deal of pushback from prominent American psychiatrists when it came out but when a filmmaker inter-viewed Insel five years later and asked him about Whitaker’s book, he responded that Whitaker’s observations needed to be taken very seriously and noted that, in other areas of medicine, if you increase the use of your medication several times, you will see reductions in morbidity and mortality.

This short glimpse of sanity in psychiatry quickly disappeared. Insel asked the right question in the first chapter of his book:⁶⁵⁰

“When it comes to mental illness, there are more people getting more treatment than ever, yet death and disability continue to rise. How can more treatment be associated with worse outcomes?”

But he didn’t give the right answers. In a most appalling fashion, Insel dismissed any worry that psychiatric drugs could be the cause of the poor outcomes. He used the tactic philosopher Arthur Schopenhauer calls making a diversion (see Chapter 4). Insel suddenly began talking of something else, as though it had a bearing on the matter. He wrote that Whitaker argues that drugs against depression and psychosis create a “supersensitivity” that makes patients dependent and chronically disabled. This is a red herring. Whether supersensitivity occurs or not (which I believe it does; see also below) is immaterial for Whitaker’s convincing findings.

Insel claimed that Whitaker writes that the psychiatric establishment, in collaboration with the pharmaceutical industry, has conspired to overmedicate and overtreat children and adults with disastrous results, and that not everyone buys this conspiracy theory.

This is mendacious. The only time Whitaker used the term conspiracy was when he quoted a patient with schizophrenia who spoke about conspiracies.^5:21 Insel used the diversion trick again and another of Schopenhauer’s tricks: “Postulate what has to be proven.”⁸³

Insel turned sand into gold by making yet a third horrific diversion. He claimed that current treatments are necessary but not sufficient to cure complex brain disorders. This has absolutely no bearing on the case. He quoted his predecessor Steven Hyman who said we need to know much more about the biology of mental illness before we “can illuminate a path across very difficult scientific terrain” and develop medications that are as effective as insulin or antibiotics.

The pompous mumbo jumbo covered up for the fact that biological psychiatry is a total failure, which history has so clearly shown. Furthermore, Insel’s ill-founded fantasies about a better future do not remove the immense harm his specialty currently inflicts on hundreds of millions of people.

Insel went further into adventure land. He thinks clinicians are more effective today than they were 25 years ago. Indeed. They are harming their patients more than ever!

Insel’s diversions multiplied. He noted that most people with mental illness are not treated; that many of those receiving drugs do not take them; and that patients receive little more than drugs. He cleverly put the blame for the poor outcomes on society for not investing in necessary social supports and on patients for failing to take their drugs and stay engaged in treatment.

This is the standard script for psychiatrists. The disaster they have created is not their fault. Others are to blame, including the patients and society. But if more patients took their drugs, the disaster would only be worse.

Nothing in Insel’s narrative would harm psychiatry’s guild interests or pharmaceutical interests. Insel described himself as taking on the role of a journalist as he explored humanistic supports that are needed to complement drugs to promote lasting recovery.

This is a win-win position to take. Anyone will welcome social support. Critics of psychiatry have advocated for such efforts for decades, and Insel now positioned himself as the advocate for this societal response. This was manipulation at the highest level. With that framework in place, there would be no place in his 300-page book for research that told of drug treatments that worsen long-term outcomes.

Instead of criticising the drugs, Insel praised them. In the chapter “Treatments Work,” he claimed that psychiatric drugs, ECT, and transcranial magnetic stimulation work and that depression pills have an effect size as high and often higher than medications used in other areas of medicine. A remarkable statement about drugs that have no clinically relevant effects. My comment on this type of argument is that one unlawful parking does not make the next parking lawful. There are many ineffective drugs in medicine that should not be used.

Insel didn’t cite a single study that told of psychiatric drugs providing a long-term benefit. This glaring omission leads to the conclusion that the former director of the NIMH is unable to find a single study to cite that told of a drug improving long-term outcomes. Insel’s book is a superb example of The Emperor’s new clothes. The Emperor is totally naked but so well dressed up that few readers will notice it.

In his book review, Whitaker provided a summary of studies Insel did not dare mention.⁶⁵⁰ In the next chapter, I will present a brief of this summary. The links to the papers can be found in the original, which is open access, and in my reference list.

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Four) appeared first on Mad In America.

More issues with unreliable diagnoses and poor drugs

A textbook called it a psychopharmacological revolution that we can alleviate or cure 80-90% of people with severe depression, and it claimed that patients with schizophrenia can get their symptoms so much under control or even become cured that they do not need to be hospitalised.^18:232 These claims go directly against the evidence. Drugs cannot cure depression or schizophrenia, and if we wait long enough, most patients, also those with severe depression or schizophrenia, will improve, which is not a drug effect.

This textbook claimed, with no references, that studies from the London School of Economics show that it is a really good business for society to offer treatment of psychiatric disorders.^18:288 Since treatment always means drug treatment—when psychiatrists don’t say otherwise—the claim is false. It is the other way around. The less we use psychiatric drugs, the greater the savings for society, and the more people will be able to work and contribute to society.^5:8,119:24

Apart from this, the textbooks did not mention economic aspects of their recommended treatments. Prices of drugs change, but there wasn’t a single remark that off-patent drugs should be preferred because they are vastly cheaper than patented drugs and not any worse than these. The psychiatric narrative was the opposite of what it should have been. We are told about new drugs that are “modern” or second-generation or third-generation drugs. Some of the drugs that have been most widely used are also some of the worst ones in terms of the harms they cause, e.g. olanzapine, paroxetine, and alprazolam.

This has nothing to do with evidence-based medicine but everything to do with corruption of the science and of the psychiatric leaders.^7,8,533 Psychiatry has sold out to the drug industry. Psychiatrists collect more money from drug makers than doctors in any other specialty,^209,639 and those who take the most tend to prescribe psychosis drugs to children most often.⁶³⁹ Psychiatrists are also “educated” with industry’s hospitality more often than any other specialty.^209,640

Lundbeck patented the active half of citalopram (Celexa or Cipramil) before the patent ran out and called the rejuvenated drug escitalopram (Cipralex or Lexapro), which it launched in 2002. When I checked the Danish prices in 2009, the rejuvenated drug cost 19 times as much for a daily dose as the original drug.^6:224 This enormous price difference should have deterred the doctors from using escitalopram, but it didn’t. Its sales were six times higher in monetary terms than the sales of citalopram. I calculated that if all patients had received the cheapest citalopram instead of escitalopram or other SSRIs, Danish taxpayers could have saved around €30 million a year, or 87% of the total amount spent on SSRIs.

Corruption, both of the science (see Chapter 8, Part Thirteen) and of the doctors, was behind this disregard for the public purse. A psychiatrist described vividly that when Lundbeck launched escitalopram in 2002, most Danish psychiatrists (there are more than a thousand psychiatrists in Denmark) were invited to an enjoyable meeting in Paris: “With expensive lecturers—of course from Lundbeck’s own ‘stable’—luxurious hotel and gourmet food. A so-called whore trip. Under influence? No, of course not, a doctor doesn’t get influenced, right?”⁶⁴¹

The textbooks claimed, without any reliable evidence, that early detection and intervention with drugs are very important for the prognosis, e.g. for psychosis, depression and ADHD. This is not correct.

A chapter on psychopharmacology written by three professors of psychiatry, Anders Fink-Jensen, Poul Videbech and Erik Simonsen, glorified the drugs.^17:645 They claimed that knowledge of brain functions has increased dramatically over the last half century; that our understanding of the mechanisms of the drugs’ effects has been strengthened; that new drugs with fewer harms and better effects have been developed; and that there is no doubt that this has decisively contributed to better psychiatric treatment for the benefit of the patients and their relatives.

All of this was wrong. Psychiatrists turn the evidence on its head to suit their own interests, which align with those of the drug industry.

A 2007 paper surveying US department chairs of medicine and psychiatry reported that 67% of them had received “discretionary funds” from industry within the last year.^7,642 This is likely an underestimate, as the survey was not anonymous. The donations to department chairs and other decision-makers are sometimes called unrestricted educational grants, which is a euphemism for corruption, as the industry doesn’t just give its money away. They are restricted uneducational grants, as their purpose is to buy doctors.⁶⁴³

The three professors’ praise of the drugs continued.^17:650 They wrote that the lack of compliance is worst for psychoses, which leads to lack of recovery, relapse and readmissions, and that the patients must understand that the diseases will have health and social consequences if the treatment is not being followed.

It is the other way around. It is very rational when some patients refuse to take toxic drugs that have no meaningful beneficial effects; that will likely harm them irreversibly; and that might even kill them. But in the psychiatrists’ delusional world, these patients are the problem, not the drugs they use.

One book was different to the others in terms of what it admitted. Right from the start, in the first chapter of the 1,065-page textbook, a psychologist and a psychiatrist noted that it is important to counteract the one-sided reductionism that neuropsychiatry has led to.^17:58 They said that diagnoses do not have much validity and have no direct consequence for the treatment and for the patients; that there is an epidemic of diagnoses, which have a life of their own; and that psychiatry has not been sufficiently cautious about the consequences of the many false positive diagnoses.

They quoted an interesting paper by Jerome Wakefield.⁶⁴⁴ His major point is that the shift to symptom-based, operationalised diagnostic criteria in DSM-III and subsequent editions of the manual missed the context in which the symptoms appear, which has led to colossal overdiagnosis—false positive diagnoses—of psychiatric disorders because the symptoms are often a normal reaction to a stressful situation.

Wakefield noted, with examples, that physicians used context for about 2,500 years to distinguish conditions like depression from normal sadness, but that this was now gone. He mentioned that the DSM-IV criteria for primary insomnia do not consider one of the commonest non-medical reasons for difficulty sleeping, a noisy environment.

Wakefield considered that this problem had urgency because the DSM’s symptom-based criteria are often applied in studies and screening instruments outside the clinical context and by nonprofessionals.

He noted, with examples, that flaws in the diagnostic criteria, which lay people can recognise immediately, remain unaddressed, and that the use of symptom checklists gives a diagnosis to many people who do not self-identify as disordered and are often not disordered. Wakefield mentioned a colleague who was seeing a depressed unemployed person and suggested medication, at which point the patient said indignantly, “I don’t need medication; I need a job.”

Wakefield noted that symptomatic criteria cannot diagnose an underlying dysfunction. For example, adjustment disorder is evaluated in part by whether there is “marked distress that is in excess of what would be expected from exposure to the stressor,” but if “what would be expected” is construed in a statistical sense, then this criterion potentially pathologises the upper range of normal variation.

Wakefield wondered why the psychiatric experts behind the DSM revisions had not looked systematically for counterexamples to the proposed criteria that could lead to false positive diagnoses.

I did exactly that in my two books about psychiatry.^7,8 I mentioned earlier that one of my colleagues, Danish filmmaker Anahi Testa Pedersen, got the erroneous diagnosis schizotypy when she became stressed over a difficult divorce.⁸ She should never have had a psychiatric diagnosis or been treated with drugs.

Since I suspected it was a dubious concept, I looked it up on the Internet and found a test for schizotypal personality disorder.^8:145,645 It is defined in various ways in different sources but the test reflects quite well the criteria on the Mayo Clinic website that notes that the symptoms are those in the DSM.⁶⁴⁶ You should reply true or false, or yes or no, to nine questions.

1. “Incorrect interpretations of events, such as a feeling that something which is actually harmless or inoffensive has a direct personal meaning.” This is a vague question, and many people interpret events incorrectly, particularly psychiatrists, or take them personally.
2. “Odd beliefs or magical thinking that’s inconsistent with cultural norms.” When a psychiatrist disagrees with the “cultural norms” about preventative treatment of schizotypy, as recommended in a textbook,^18:106 is he then abnormal? And what about monstrous overdoses, which is also a “cultural norm” in some places? It seems that those in the staff who protest are normal but would be considered abnormal according to this question.
3. “Unusual perceptions, including illusions.” I have provided evidence in my books including this one that most psychiatrists would need to say yes to this question. Just think about the illusion called the chemical imbalance.
4. “Odd thinking and speech patterns.” Most psychiatrists display odd thinking, about the chemical imbalance and many other issues, and they deny totally what other people see clearly, including their own patients, e.g. that psychiatric drugs do more harm than good.
5. “Suspicious or paranoid thoughts, such as the belief that someone’s out to get you.” If you are detained in a psychiatric department, such a reaction is normal and understandable. The staff is surely out to “get you,” namely to treat you forcefully with psychosis pills against your will. When psychiatric leaders use terms about their critics such as “anti-psychiatry” and “conspiracy,” is it then a “yes” to this question?
6. “Flat emotions, appearing aloof and isolated.” This is what psychiatric drugs do to people. If they were normal to begin with, the psychiatrists will ensure that this won’t last.
7. “Odd, eccentric or peculiar behaviour or appearance.” One definition of madness is doing the same thing again and again expecting a different result, which is what psychiatrists do all the time with their drugs. I would call that an odd, eccentric, and peculiar behaviour.
8. “Lack of close friends or confidants other than relatives.” This is what psychiatric drugs do to people, particularly psychosis pills; isolate people and make zombies out of them.
9. “Excessive social anxiety that doesn’t diminish with familiarity.” If you are detained in a psychiatric department, such a reaction is normal and understandable.

Many, perhaps even most, psychiatrists would test positive. What is less amusing is that the test provides circular evidence because patients who are normal might test positive after they have been treated inhumanely by psychiatrists.

When I discuss the state of psychiatry with critical psychiatrists, psychologists and pharmacists I collaborate with, they sometimes ask: “Who are most mad, the psychiatrists or their patients?” An Oxford dictionary defines delusion as “An idiosyncratic belief or impression maintained despite being contradicted by reality or rational argument, typically as a symptom of mental disorder.” According to this, the most vocal leading psychiatrists suffer from delusions.

I was once invited to follow the chief psychiatrist’s round at a closed ward.^8:68 We talked with several patients, and one of them appeared normal and reasonable to me, but to my big surprise, the psychiatrist asked me if I could see that he was delusional. As I couldn’t, he explained that the patient was delusional because he had been on the Internet and had found out that psychosis pills are dangerous. I replied that they are indeed dangerous and that there is nothing delusional in believing this. I was so stunned that I said no more. This psychiatrist was not just anybody. He had a high position at the Danish Psychiatric Association.

On another occasion, I phoned a psychiatric department that has a bad reputation because of the patients the psychiatrists have killed there with their drugs, including Luise.²³⁴ A desperate patient in great distress had rung me, but I couldn’t get through to a psychiatrist, even though I was a colleague and it was within normal working hours. I was transferred to a head nurse who told me not to become involved because the patient was delusional. When I asked her in what way, she said he had found out that psychosis pills were dangerous. I asked her if she knew whom she was talking to. Oh yes, she knew about me.

Psychiatry is characterized by such insanity. The psychiatrists’ delusions are not shared by people considered sane, e.g. the general public, but they forcefully maintain them, even when the most reliable science has clearly shown that their beliefs are wrong. When I point this out to them, they have no shame or regrets.

If psychiatry had been a business, with competition, it would have gone bankrupt long ago.

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Three) appeared first on Mad In America.

Censorship in medical journals and the media

It is very difficult to get anything published in a psychiatric journal that the psychiatric guild perceives as threatening for their carefully pruned self-image and wrong ideas.^8:151

Editors of specialty journals are often on drug industry payroll and journal owners also often have too close relations to the drug industry.^6-8,27,630

At the inaugural symposium for my Institute for Scientific Freedom in 2019, Robert Whitaker spoke about scientific censorship in psychiatry. He focused on two topics of great importance for public health: Do antidepressants worsen long-term outcomes? and What do we know about post-SSRI sexual dysfunction?⁶³¹ None of 13 and 14 pivotal studies, respectively, about these subjects had been published in the top five psychiatric journals, which did not even appear to have discussed the issues.

The censorship in mainstream media is also pronounced. When my first psychiatry book had been translated into Swedish, I was interviewed by journalists from two major newspapers in Stockholm.^8:152 They were very interested, but as nothing was published, I asked why. One journalist didn’t reply. The other said that her editor thought it would be too dangerous to explain to Swedish citizens that depression pills are dangerous, as they can cause suicide. Both newspapers were right-wing. In contrast, a third newspaper, Aftonbladet, popular with Social Democrats, allowed me to publish an article that filled the whole back page, with no censorship.

It is also very difficult to get critical documentaries on national TV, and if you succeed, you can be dead sure that the best parts have been removed, “so we don’t upset anyone or get too many complaints from the psychiatrists, the drug industry or the Minister.” And there is an untruthful voiceover telling the audience that “many people are being helped by psychiatric drugs.”⁸

It is difficult to publish relevant books, too.⁸ In one case, a former patient and a filmmaker came to film me for a documentary.⁶³² The patient had an agreement with a book publisher about what she thought was a psychiatric success story. But psychiatry had stolen 10 years of her life and when I explained that she had been horribly harmed by her psychiatrists, which were very close to driving her into suicide with fluoxetine, she accepted my explanations. When her psychiatric “career” was no longer a success story but a scandal, the publisher backed out. Her drug list is one of the worst I have ever seen.^8:154 It is a miracle she survived all this.

Another Norwegian filmmaker wanted to have me on the panel when her documentary, Cause of Death: Unknown,”⁶³³ had world premiere in 2017 at the Copenhagen documentary film festival (CPH:DOC). The cause of death was not unknown. The filmmaker’s sister was killed by her psychiatrist who overdosed her with olanzapine, which turned her into a zombie. The psychiatrist was so ignorant that he didn’t even know that olanzapine can cause sudden death. Such iatrogenic deaths are called natural deaths by the authorities.

I appeared in the film and my name was the only one in the announcement: Medicine or manipulation? Film and debate about the psychiatric drug industry with Peter Gøtzsche. Seven days before the film was to be screened, I was kicked off the panel under the pretence that the organisers couldn’t find a psychiatrist willing to debate with me. This was not the real reason. It turned out that the Lundbeck Foundation, whose objective is to support Lundbeck’s business activities, had provided a major grant to the festival. CPH:DOC never contacted me about it, even though I could easily have named several psychiatrists willing to debate with me.

I have described this scandal elsewhere.^8:155 The panel discussion was a farce that protected the status quo and people in the audience became angry. It was deeply insulting to them to show a film about a young woman killed by Zyprexa without allowing any of those who had lost a family member in the same way to say anything. It was a brutal dismissal and a total prostration for Lundbeck.

Another recent instance of censorship involved Danish public TV. Independent documentary filmmaker Janus Bang and his team had followed me around the world for several years because they wanted me to play a central role in their documentaries about how awful and deadly psychiatry is. Janus ran into a huge roadblock and needed to compromise extensively to get anything out on TV. He broadcast three interesting programmes in 2019, The Dilemma of Psychiatry, but the public debate he so much had wanted to have major reforms introduced was absent. Drug exports are Denmark’s biggest source of income, and there were embarrassing, false voiceovers paying lip service to Lundbeck and the psychiatrists. And me? I wasn’t allowed to appear at all.

Journalists have told me that the reason Danish public TV doesn’t dare challenge psychiatry or Lundbeck is due to two programmes sent in April 2013.

I was interviewed for Denmark on Pills, which featured three patients. One was prescribed “happy pills” when she was 15 and suffered from massive harms. Another had lost his sex drive and shouldn’t have had the pills at all, as he was not depressed but suffered from stress. The third was a boy diagnosed with ADHD by a psychiatrist who had never met him.

Already the next day, the psychiatric empire stroke back. In a magazine for journalists, Poul Videbech said:⁶³⁴ “It’s a scare campaign that can cost lives. I know several examples of suicide after friends and family advised the patient to drop antidepressant medication.” Videbech com-pared this with journalists making programmes advising patients with diabetes to drop their insulin even though he, at the same time, fiercely denied that he believed in the myth about the chemical imbalance (see Chapter 4).

There were many commentaries to the article about Videbech in the magazine. One noted that it was interesting to see that there were virtually no tapering programmes in psychiatry and that people often ended up on lifelong medication.

One mentioned that she was a member of a large and diverse group of people who had warned for years against the uncritical use of drugs and had spent time on helping the victims, but every time they opened a debate on this topic, they were accused of not thinking about those who benefit from the medicines.

One wondered why we heard nothing from psychiatry about the suicides and suicide attempts the drugs cause: “…dismissed as non-occurring. Nevertheless, it was on the list of side effects in the package insert of the medication I received. And I felt the impulse on my own body. But I was told that it was my depression that was the trigger for suicidal thoughts and plans. The strange thing about that was that the impulse came shortly after I started on the drug … But the doctor and others involved concluded that my dose should be increased, which I luckily declined and I decided to taper off the drug on my own. That people change their personality totally—become aggressive and hot-headed, paranoid, etc.—is also dismissed.”

One noted that I was right that the media had been uncritical in their coverage of psychiatric drugs. He pointed out that many people had tried to warn against them for many years but had been silenced or fired from their positions from where they could reach the population.

This also happened to me which I wrote a book about.⁶³⁵ I updated it¹⁴⁶ (freely available) because Janus Bang and I are currently making a documentary film about the affair, which we base on crowd funding (see scientificfreedom.dk/donate/).

Only four days later, journalist Poul Erik Heilbuth showed a brilliant 70-minute documentary, The Dark Shadow of the Pill. He documented in detail how Eli Lilly, GSK and Pfizer had concealed that their depression pills cause some people to kill themselves or commit murder or cause completely normal and peaceful people to suddenly start a spree of violent robberies in shops and gas stations they were unable to explain afterwards and were mystified about. The pills changed their personality totally.

Heilbuth had whistleblower Blair Hamrick in his film, a US GSK salesman  who said that their catchphrase for paroxetine (Paxil or Seroxat) was that it is the happy, horny and skinny drug. They told doctors that it will make you happier; you will lose weight; it will make you stop smoking; it will make you increase your libido; everybody should be on this drug. Hamrick secretly copied documents, and GSK was fined $3 billion in 2011 for paying kickbacks to doctors and for illegal marketing of several drugs, also to children.^6:27

An editorial in one of Denmark’s national newspapers, Politiken, condemned the documentary in an unusually hostile fashion and called it “immensely manipulative,” “sensationalism,” “merely seeking to confirm or verify the thesis that the programme had devised as its premise,” and they called one of the well-argued experts a “muddled thinker.”

Two days after Heilbuth’s documentary, I debated with Lars Kessing on live TV about suicides caused by depression pills. Bits of this debate appears in the documentary, Diagnosing Psychiatry.⁶³⁶ Kessing totally denied the science and the drug agencies’ warnings, saying that we know with great certainty that SSRIs protect against suicide. He added that the risk of suicide is large when people stop SSRIs but failed to mention that this is a drug harm, as the patients go through cold turkey withdrawal.

Three days later, I was in a TV debate again with Kessing, this time about how we could reduce the consumption of depression pills. Kessing claimed that they are not dangerous. Lundbeck‘s director of research, Anders Gersel Pedersen, said that the most dangerous thing is not to treat the patients, and he claimed that the patients don’t become addicted but get a relapse when they stop taking the pills. Kessing claimed that perhaps only 10% of those who visit their family doctor are not helped by the medicine, quite a remark about drugs that don’t work (see Chapter 8).

When Kessing was asked by the interviewer how the consumption of pills could be reduced—no matter what he might think about its size—he didn’t answer the question. He said we knew for sure that there had been a rising incidence of moderate to severe depression over the past 50 years. I replied that we could not tell because the criteria for diagnosing depression had been lowered all the time during this period.

Kessing was wrong. Psychiatrists constantly tell me that the prevalence of severe depression has not increased.¹⁰³ Most patients who get a diagnosis of depression live depressing lives, e.g. are married to the wrong person, have a bullying boss, a tedious job, or a chronic disease. It is not the job of doctors to try to get them out of this predicament and a pill won’t help.

I have experienced that when journalists react violently and go directly against the scientific evidence and the authorities’ warnings, it is almost always because they think the pills have helped them or someone close to them, or because a relative works for Lundbeck or is a psychiatrist. I have been exposed to many vitriolic attacks. It is sad that journalists throw everything they learned at journalism school overboard and explode in a cascade of rage and ad hominem attacks, but that can happen if you tell the truth about depression pills. You are attacking a religion and violating one of the most sacred taboos in healthcare.

In a radio debate, Mind’s National Chairman, Knud Kristensen, argued that some of their patients had said that depression pills had saved their life. I responded dryly that it was an unfair argument because all those the pills had killed couldn’t raise from their graves and say the pills killed them.

Robert Whitaker has provided a long list of important and large studies whose results were threatening to the psychiatric narrative and which were not mentioned in any US newspapers.^5:307 When the WHO study came out (see Chapter 7, Part Three), the New York Times reported that “schizophrenics generally responded better to treatment in less developed countries.”^5:311 This is highly misleading because any reader would think they were treated with psychosis pills, which they rarely were.

A few mainstream psychiatric journals have started to wake up to the disaster. A 2007 paper in the British Journal of Psychiatry stated that the research into biological mechanisms of mental and behavioural responses has failed to deliver anything of value to clinical psychiatrists and is very unlikely to do so in future,⁵⁹⁶ and a 2012 paper in this journal predicted that the current biology-based model will be ruinous to the profession due to its consistent failure to deliver.⁶³⁸

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part Two) appeared first on Mad In America.

The industry has bought doctors, academics, journals, professional and patient organisations, university departments, journalists, regulators, and politicians. These are the methods of the mob.
—Richard Smith, previous editor of BMJ^6:viii

What makes this book new and worth your attention? The answer is simple: the unique scientific abilities, research, integrity, truthfulness, and courage of the author. Gøtzsche’s experience is unequaled.
—Drummond Rennie, editor of JAMA⁶

These are extracts from the forewords to my 2013 book about organised crime in the drug industry.⁶ I have shown in this book that you cannot trust the randomised trials, the drug industry, or the psychiatric leaders. The editors say in their forewords to my 2013 book that I can be trusted but, more importantly, I have tried to document what I say so you can make up your own mind.

You cannot even trust the drug regulators. As David Healy has pointed out, in contrast to drug agencies, airline pilots are critically concerned with our safety because if we go down, they do too.⁶¹⁷ There is widespread corruption in the FDA at the highest levels, including several commissioners,⁶ and in 2009, nine FDA scientists wrote to President Obama about this.^618,619 In 2012, it was revealed that FDA management had installed spyware on the computers of five scientists who had alerted the FDA to safety problems to no avail and therefore had informed the politicians.⁶²⁰

It must be very tempting for drug companies to bribe officials at drug agencies. There is an enormous amount of money at stake and the approval of a new drug can be the difference between life and death for a company. In 2012, Danish Lundbeck and its Japanese partner Takeda submitted vortioxetine, an SSRI, for regulatory approval in the United States.⁶²¹ Lundbeck’s blockbuster, escitalopram, was running out of patent, and the company would receive a $43 million milestone payment from Takeda if FDA accepted the drug.

It is paradoxical that, while drug firms don’t trust each other, drug agencies are supposed to trust the entire industry because they cannot review more than a tiny fraction of the mountains of documents they receive.⁶²² The regulators don’t even check that everything is included. I have found numerous examples that whole appendices or many pages in the middle of a report were missing,^279,326 and also of missing cases of suicidality,²⁷⁹ in clinical study reports of placebo-controlled trials submitted to European drug regulators for marketing approval.

Psychiatry’s narrative is that drugs are very often needed, both in the acute phase and long-term to prevent relapse; that specific drug treatments have been known for about 65 years;^18:232 that the drugs are generally effective and safe; and that the new psychiatric drugs are highly beneficial.^18:307

The truth is that none of the many psychiatric drugs have specific effects; the drugs rarely have clinically relevant effects and are therefore rarely needed, not even in the acute phase; an effect on relapse has not been demonstrated; and the drugs are far from being safe. There is an epidemic of overdiagnosis and overtreatment with psychiatric drugs to such an extent that, based on the most reliable research I could find, I estimated that psychiatric drugs are the third leading cause of death, after heart disease and cancer.^7:12,7:307

The denial of the facts in the psychiatric profession is massive. In 2011, a group of prominent psychiatrists wrote:⁶²³

“Persistent, untreated depression produces a type of neurodegenerative disorder, associated with synaptic changes … Similar to poor control of blood sugar in diabetics, poor control of symptoms in Major Depression is associated with worse long-term outcome and greater overall disability … antidepressants prevent relapses … 53% of the placebo patients relapsed, whereas only 27% of drug-treated patients relapsed … After the FDA issued a black warning [sic] against antidepressants … there has been a concomitant increase in actual suicide … There have been concerns regarding whether certain antidepressants may cause suicides. We now know this is a myth largely fuelled by the media … Newer studies of children do not confirm an increase in suicidal ideation … Naturalistic studies show that the incidence of the suicide rate tends to go down as the incidence of antidepressant treatment goes up.”

I fail to understand how Stefan Leucht, who has published much good research and is an editor in the Cochrane Schizophrenia Group, could co-author this harmful nonsense. It shows that the collective delusions and denial in psychiatry hit even the best psychiatrists. It is very tragic for the patients, their relatives, and psychiatry itself.

A 2012 newspaper article written by four leading Danish psychiatrists called Behind the Myths About Antipsychotics was similarly tragic.⁶²⁴ They wrote that most patients suffering from schizophrenia have disturbances in the dopamine system; the genes are by far most important (about 70-80%); large international registry studies show that patients with schizophrenia who are not treated with psychosis drugs are at higher risk of dying prematurely than patients who are in treatment; numerous studies have documented that the risk of new psychotic episodes and a more severe course of the disease is increased if patients stop taking psychosis drugs; that they found no indications that polypharmacy with psychosis drugs increases mortality in their large study; and that large register-based studies in Denmark and Finland show that concomitant treatment with several psychosis drugs is not associated with increased mortality.

Leading psychiatrists constantly tell the public such nonsense, which is dangerous for their patients. They claim that psychosis pills reduce mortality when the truth is the opposite, and they happily continue their Titanic course towards the iceberg, which they refuse to see.

Here is a patient story from one of the psychiatrists’ university hospital in Copenhagen.^7:277 A patient was admitted with mania, and although he asked not to be treated with drugs, he received forced treatment with olanzapine. In his own words: “At discharge, when I had been declared cured after my first-episode mania, I tried to behave well, fearing that I might not be released. The psychiatrist forcefully urged me to continue with olanzapine. I didn’t dare tell her that I had spat out most of the pills in the washbasin and therefore asked, for the sake of appearances, for how long she thought I should take the drug? For the rest of my life, she replied, because I had a chronic disease, with a great risk of relapse, and I should not be afraid of the harms.”

The reason why the patient didn’t take the drug was that he had read the newspaper article I published in January 2014 about ten harmful myths in psychiatry, which also exists in English,¹⁸⁹ and he has been well ever since without drugs.

The same day my article about the ten myths appeared, Thomas Middelboe, chairman of the Danish Psychiatric Association declared in the same newspaper, on its website:⁶²⁵ “Antidepressant drugs protect against suicide.” A month later, 16 Danish professors in psychiatry responded to my article⁶²⁶ without mentioning my name, just like one was not supposed to mention the evil Voldemort’s name in Harry Potter. They wrote that a number of studies show that treatment with psychosis drugs increase longevity, compared with no treatment.

I have given many examples in this book that leading psychiatrists have no problem with claiming the exact opposite of the truth. In 2005, Steven Sharfstein, then president of the American Psychiatric Association, wrote that “Pharmaceutical companies have developed and brought to market medications that have transformed the lives of millions of psychiatric patients.”⁶²⁷ Sure, but not for the better. He added that “Big Pharma has helped reduce stigma associated with psychiatric treatment and with psychiatrists.”

Is there any hope for a specialty like this? I have heard critical psychiatrists say that their leaders suffer from cognitive dissonance, as what they see and hear doesn’t influence them. Many books have documented that the psychiatric leaders have given up rational thinking for the benefits they acquire themselves from supporting a totally sick system. Even psychiatrists who have used monstrous overdoses of psychosis pills are allowed to practice.^8:143 Why don’t our politicians care that incompetent psychiatrists kill hundreds of thousands of their patients every year (see Chapters 7 and 8)? Or that the lives of many millions of children get destroyed?

Psychiatric drugging of children is a form of child abuse that should be prohibited, with rare exceptions. We are not allowed to beat our children but are allowed to destroy their brains with drugs. We medicalise the conflicts that arise between parents and children, and methylphenidate has become the modern version of the cane. This is a flagrant abuse of a faulty disease model.

Little has changed in recent years. If you google what causes ADHD, you can find this misinformation from the UK National Health Service, directed toward the public and last reviewed in December 2021:^10:39,628

“ADHD tends to run in families and, in most cases, it’s thought the genes you inherit from your parents are a significant factor in developing the condition … Research has identified a number of possible differences in the brains of people with ADHD from those without the condition … Other studies have suggested that people with ADHD may have an imbalance in the level of neurotransmitters in the brain.”

The drugged child’s brain cannot develop in its intended manner but develops in response to a toxic internal environment. The stigmatisation and loss of self-esteem, which often follows psychiatric diagnosis and treatment, is especially ominous in children who have yet to shape their personalities, and it can hamper future opportunities even without considering the potential brain damage caused by the drugs. Children may learn to view themselves as physically or genetically disabled, with impaired self-determination and increased feelings of helplessness.⁵²⁶ This cruelty must be stopped.

Imagine if a virus suddenly appears that makes people sleep 12-14 hours a day and move around slowly and become emotionally disengaged.^5:207 Some gain 30 kg of weight, their blood sugar and cholesterol go up, and they develop diabetes. People infected die substantially earlier than other people, some kill themselves, and parents panic over the thought that their children might also contract this horrible disease. Scientists find out that the virus blocks a multitude of receptors in the brain—dopaminergic, serotoninergic, muscarinic, adrenergic, and histaminergic—which lead to compromised brain function. MRI studies find that the virus shrinks the cerebral cortex, which is tied to cognitive decline. A terrified public clamours for a cure.

Such an illness has hit millions of children and adults. It is not a virus. It is Eli Lilly’s bestselling psychosis drug, olanzapine (Zyprexa). But since it is a drug, we do nothing. Drugs are taboo.

The only hope we have is if people protest so vigorously that it becomes an unstoppable revolution.

In 2017, a young Swedish psychiatrist, Joakim Börjesson, came to Copenhagen to do research with me.⁴²⁸ He became very impressed during his medical studies when a psychiatrist told the students that they knew so much about the brain and the drugs that they could use drugs that were specifically targeted to work on a disorder’s biological origin, the so-called chemical imbalance idea. He found it so fascinating that he decided to become a psychiatrist.

Joakim is cleverer than most of his colleagues. After having read books by Robert Whitaker and me, he realised that he had been totally fooled and considered leaving psychiatry.

In January 2018, he arranged a session in Göteborg during the annual conference for 150 Swedish psychiatrists in training where I debated with clinical pharmacologist and professor Elias Eriksson about SSRIs.^8:147

During the session, I mentioned that Eriksson had entered a secret agreement with Lundbeck against his university’s rules, which meant that Lundbeck could prevent publication of his research if they didn’t like the results. I said this because Eriksson routinely “forgets” to declare his conflicts of interest, but I was immediately stopped by the chair. Later, the Ombudsman criticised the university for covering up the affair.⁶²⁹

What is typical for debates with people who try to defend a sick system also happened this time. Eriksson broke the rules for the debate, he lied, and he used dirty tricks in his attempts at convincing the audience that I could not be trusted. Joakim informed me that Eriksson had said before the session that he had the intention to “‘reveal that Peter Gøtzsche is a charlatan’ during his lecture. We then discussed this for about an hour and I fruitlessly tried to convince him to adhere to the rules for the debate with no success.”

Eriksson claimed that none of the harms of the pills were irreversible; that they were not addictive; that criticism of the pills was “ideologically founded”; and that their use according to the critics was the result of a worldwide conspiracy that included psychiatrists, researchers, authorities and drug companies. Five months earlier, when I debated with Eriksson on Swedish radio, he said the pills helped dramatically and prevented suicide.

After the meeting, I was told that many psychiatrists had not understood my explanations about depression pills causing suicide. When I present the same slides for a lay audience, they always understand them. The psychiatrists don’t want to understand what is too painful for them.

In 2013, when Robert Whitaker was invited to speak at a meeting in Malmö that child psychiatrists had arranged, other psychiatrists intervened and got control of the meeting. They requested that he should only speak about the dopamine supersensitivity theory and not present any data on long-term outcomes.

When he arrived, Bob was told that Eriksson would be his opponent, and he spent his time denouncing Bob in an unbelievably dishonest fashion. In Bob’s own words: “The whole thing was a disgusting setup that stands out for its complete dishonesty, from start to finish.” Eriksson declared that he considered Bob to be a “charlatan who tortures patients.”

I had planned on coming, but Eriksson declared that he would not participate if I showed up.

It is strange how psychiatry’s apologists constantly call their opponents charlatans or worse and use strawman arguments. None of us have ever postulated anything about a “conspiracy.”

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 16: Is There Any Future for Psychiatry? (Part One) appeared first on Mad In America.

Psychiatrists and other doctors know very little about abstinence symptoms, which they mainly reject, and about how to taper off psychiatric drugs safely.¹³⁵ One should never start psychiatric drug treatment without having a tapering plan, but no one taught doctors how to stop the drugs, whereas they have learned from their professors and the pharmaceutical industry when to start them and always to blame the disease for untoward symptoms, ignoring the troubles they have caused.

It is much easier to renew a prescription than to stop an addictive drug, and it generates a much greater income, as more patients can be seen in a day.

Patients who want to stop drugs are mostly left to fend for themselves and they share their experiences on the Internet and on social media. This is the reason why I thought it might be valuable to write a book about why and how to withdraw psychiatric drugs.⁸ Volunteers found the book so important that they translated it into Spanish, French and Portuguese. It is available in these languages on my website, scientificfreedom.dk, and has also appeared in print in English,⁸ Danish, Swedish, Dutch and Italian.

Few people can taper off the drugs themselves, and psychiatrists may feel disrespected when patients ask to come off the drugs they have instituted. A common notice in hospital patients’ charts is: “The patient doesn’t want drugs. Discharged.” It is therefore often psychologists, other therapists, pharmacists, friends and relatives that help patients come off their drugs.

Most patients are unable to judge themselves because the drugs have changed their brains. When in the midst of painful psychiatric drug withdrawal, their brain is in a state of drug-induced crisis and it is truer than ever that they cannot believe what their mind tells them. Patients will usually feel they are themselves and will try to explain away their odd behaviour if confronted with it. They will often totally deny that they have become irritable, agitated, hostile or difficult in other ways and will react with anger over such “accusations.”^21,135

This is one of the reasons it is so essential that patients are not alone, but that close relatives or friends can observe them carefully. It can be dangerous if the patient’s false explanations are accepted. The patient should therefore allow friends and family to contact the therapist if they are concerned.¹³⁵ When patients have left suicide notes, only very rarely is there any indication that the drug was the problem; patients don’t know this and think they have gone mad.^7:79

It often requires strong determination, a lot of time, patience, and a long tapering period to come off the drugs while making the abstinence symptoms bearable. It can usually be done within a few months but can take more than a year. Psychiatrist Jens Frydenlund has told me that his record is eight years for an SSRI. He has worked with drug addicts for decades, and, like other psychiatrists who have experience with both legal and illegal drugs,¹³⁵ he says that it is generally much easier to stop heroin than to stop a benzodiazepine or an SSRI because the abstinence symptoms with heroin disappear rather quickly.

What we need more than anything else in psychiatry are withdrawal clinics, with easy and quick access free of charge, and education about the harmful effects of psychiatric drugs, how to stop them, and above all: How to avoid starting them. Public investment in such clinics would be highly profitable and beneficial in terms of fewer disability pensions, fewer suicides and other drug deaths, much healthier citizens, and fewer serious crimes.

Nurses, psychologists, social workers, teachers and other non-prescribing people have often been taught that their task is to push people to get a diagnosis and to comply with the prescribed medication. They should be taught the opposite, that psychiatric diagnoses should be avoided and that drugs should be used for as short a time as possible and preferably not at all.

Patients don’t care about the academic wordplays whose only purpose is to allow the drug companies to continue intoxicating whole populations with mind-altering drugs. The patients know when they are dependent; they don’t need a psychiatrist’s approval that their experience is real, and some say the withdrawal from a depression pill was worse than their depression.⁶⁰⁸

The patients have been fooled by their doctors who were fooled by their leaders who were fooled by the drug industry. A recent survey of 1829 New Zealanders who were on depression pills showed that only 1% had been told anything about withdrawal effects or addiction.⁶⁰⁹

Progress is very slow. In 2020, the UK mental health charity Mind said it signposted people to street drug charities to help them withdraw from depression pills because of the lack of available alternatives. A voiceover said on BBC about this initiative: “Although they are not addictive, they can lead to dependency issues.” What’s the difference?

In November 2019, the Danish National Board of Health issued a guideline about depression pills to family doctors that was dangerous. As I knew from experience that it doesn’t lead anywhere to complain to the authorities, I published my criticism in a newspaper article.¹⁹⁵ The Board of Health was given the opportunity to respond but declined—a sign of the arrogance at the top of our institutions related to important public health issues. They won’t admit they got it wrong.

Although the author group for the guideline included a psychiatrist and a clinical pharmacologist, they didn’t seem to know what a binding curve for depression pills to receptors looks like (see graph).

Hyperbolic relationship between receptor occupancy and dose of citalopram in mg

(Courtesy of Mark Horowitz²⁸¹)

As with other medicines, the binding curve is hyperbolic. It is very steep in the beginning when the dose is low, and flattens out and becomes almost horizontal at higher doses.^281,610

It is important to be familiar with these issues. With my Danish colleagues, who have with-drawn many patients, I have written repeatedly about the principles in Danish newspapers and elsewhere since 2017. It is therefore strange that the board recommends halving the dose of depression pills every two weeks, which is far too risky.

At usual dosages, most receptors are occupied because we are at the top of the binding curve where it is flat. Since virtually all patients are overdosed, they might remain on the flat part of the binding curve after the first dose reduction and not experience any withdrawal symptoms. It could therefore be okay to halve the dose the first time. But even this might cause problems because psychiatric drugs are nonspecific and influence more than one type of receptor.²⁸¹ We don’t know the binding curves for all these receptors. The patient could be on the steep part of the curve for one of the receptors at the start, or on the steep part in particular regions of the brain.

Already the next time, when going from 50% of the starting dose to 25%, things can go wrong. Should the withdrawal symptoms not occur this time either, they will almost certainly come when you take the next step and come down to 12.5%.

It is also too fast for many patients to change the dose every two weeks. The physical dependence can be so pronounced that it takes many months or years to fully withdraw from the pills.

As noted earlier, fast withdrawal can cause akathisia, which predisposes to suicide, violence, and homicide.

A withdrawal process must respect the shape of the binding curve, and become slower and slower, the lower the dose. These principles have been known for many years and were explained in an instructive paper in Lancet Psychiatry in March 2019,²⁸¹ eight months before the Danish National Board of Health published its dangerous guideline.

After decades of inaction and denial,⁷ some progress is now being made. I co-founded Council for Evidence-based Psychiatry in 2014 and, as noted earlier, I was immediately attacked by the top of British psychiatry.³⁰² I requested and was granted an opportunity to publish a rebuttal of their nonsense.³¹¹ The Council was established at a meeting in the House of Lords by filmmaker and entrepreneur Luke Montagu who had suffered horribly from withdrawal symptoms for many years after he came off his psychiatric drugs,^8:97 and he wanted to highlight their harms.

After setting up the Council, Luke founded the All-Party Parliamentary Group on Prescribed Drug Dependence (APPG), which successfully lobbied the British Government to recognise the issue. He also succeeded to get support from the British Medical Association and the Royal College of Psychiatrists. That led to a ground-breaking review by Public Health England with several key recommendations, including a national 24-hour helpline and withdrawal support services.³¹⁰ These recommendations do not only focus on the traditional culprits, opiates and benzodiazepines, but also on depression pills.

In December 2019, the APPG and the Council published the 112-page Guidance for Psychological Therapists: Enabling Conversations with Clients Taking or Withdrawing from Prescribed Psychiatric Drugs.⁶¹¹ This guide is very detailed and useful, both in relation to the individual drugs and in terms of the guidance offered to therapists.

In 2016, I co-founded the International Institute for Psychiatric Drug Withdrawal (iipdw.org), originally based in Sweden, now in the UK.

I have not had success with Danish parliamentarians. Although they were always positive when I explained why major changes are needed in psychiatry, they are afraid of going against the psychiatrists who are quick to tell them that psychiatry is outside their area of expertise.

Mind, the most influential organisation for psychiatric patients in Denmark, wasn’t forthcoming either. When I tried to get an advertisement in their member journal in 2017 for a withdrawal course I planned for psychiatrists, patients and others, they refused to accept my ad.^8:99 But after I went to their headquarters with a documentary film crew, they felt pressured to give in to my reasonable request, which was in their members’ interest.

When I informed Psychiatry in the Capital Region about our course, Poul Videbech complained about to the Patient Safety Authority, which did not react to his complaint until five months later when we had already held the course. They noted they did not intend to take any action.

By the end of 2017, psychiatrist Jan Vestergaard tried to get a two-hour symposium about drug withdrawal on the programme for the annual meeting of the Danish Psychiatric Association in 2018. Even though the meeting lasted four days, with parallel sessions, the board declared there wasn’t room for the symposium. Vestergaard had asked me to speak at his meeting and I did not accept this censorship. I booked a room at the conference hotel and held a two-hour symposium for the psychiatrists in the morning, which we repeated in the afternoon. I mentioned in the ad in the Journal of the Danish Medical Association that several psychiatrists had urged us to hold a course on withdrawal of psychiatric drugs at the same time as their annual meeting.

My PhD student on the subject, Anders Sørensen,⁶⁰⁷ also lectured. Later, when we strolled around in the corridors, we learned that young psychiatrists had been scared away from attending because their bosses would see them as heretics and might retaliate, but the room was pretty full, nonetheless.

On other occasions, psychologists, social workers, and nurses who wished to attend my lectures or courses have told me similar stories about receiving dire warnings from their superiors that if they showed up, it would not be well received at their department. This is diagnostic for a sick specialty. It tells a story of a guild that behaves more like a religious sect than a scientific discipline because in science, we are always keen to listen to new research results and other points of view, which make us all wiser.

The Cochrane Collaboration, which I co-founded in 1993, was also uncollaborative.^8:106 Anders and I had submitted a protocol for a Cochrane review of studies of withdrawal of depression pills, but the editors sabotaged it. The Cochrane depression group sent us on a two-year mission that was impossible to accomplish, raising their demands to our protocol to absurd levels with many irrelevant requirements, including demands of inserting marketing messages about the wonders that depression pills can accomplish, according to psychiatric dogma. Cochrane did its utmost to defend the psychiatric guild, its many false beliefs, and the drug industry, forgetting that its mission is to help patients.

It was bizarre. In the midst of all our troubles, Anders wrote to me that our review was quite simple, as we just wanted to help people wishing to come off their drugs but weren’t allowed to do so: “What kind of world is this?”

The 8th and final reviewer functioned as hangman. He denied a long array of scientific facts and used strawman arguments accusing us of things we had never claimed. We were accused of “painting a picture” about avoiding depression pills, which did not represent the scientific consensus.

The reviewer wanted us to “Start with a statement as to why antidepressants are considered by the scientific community to be beneficial … in treating a broad range of highly disabling and debilitating mental health problems” and accused us of being unscientific because we had not mentioned the beneficial effects. We responded that our review was not an advertisement for the drugs and that it was not relevant to discuss their effect in a review about stopping using them. Furthermore, a Cochrane review should not be a consensus report.

The editors also asked us to write about the benefits and to mention that “some antidepressants may be more effective than others”, with reference to the fatally flawed 2018 network meta-analysis in Lancet by Andrea Cipriani and colleagues (see Chapter 8, Part Thirteen).²⁷¹

A Cochrane editor asked us to describe how depression pills work and what the differences are between them, and a reviewer wanted us to explain when it was appropriate and inappropriate to use depression pills. But we were not writing a textbook in clinical pharmacology, we were just trying to help the patients come off their drugs.

We wrote in our protocol that “Some patients refer to the discredited hypothesis about a chemical imbalance in their brain being the cause of their disorder and therefore also the reason for not daring to stop.” The hangman, who believed in the chemical imbalance nonsense, opined that we dismissed many decades of evidence of neurochemical changes observed in depression and accused us of having suggested with no evidence that prescribers perpetuate untruths to justify drug prescription. He also wanted us to mention ongoing prophylactic depression pill treatment, “a well-accepted clinical strategy,” which was outside the scope of our review. Moreover, all the maintenance studies are flawed. We were wrongly accused of having conflated relapse with withdrawal symptoms, and the hangman argued that most people who had taken depression pills for extended periods could stop safely without problems, which is blatantly false.

He also wanted us to remove this sentence: “the patients’ condition is best described as drug dependence” referring to the DSM-IV drug dependence criteria. We replied that, according to these criteria, no one who smokes 20 cigarettes every day is dependent on cigarettes.

The level of denial, obfuscation, confusion and censorship was so high that I saw this as one of several signs of the impending death of Cochrane as an organisation.¹⁴⁶

We will publish our review in a journal whose editors are not morally and scientifically corrupt and who have the patients’ interests at heart. We uploaded all 8 peer reviews, our comments to them, and our final protocol, as part of an article we published about the affair in 2020.⁶¹²

The psychiatrists and other doctors have made hundreds of millions of people dependent on psychiatric drugs and yet have done virtually nothing to find out how to help them come off them again. They have carried out tens of thousands of drug trials but only a handful of studies about safe withdrawal.

Many psychiatrists continue to turn a blind eye to the disaster they have created and argue that we need more evidence from randomised trials, but such evidence is unlikely to be helpful, as withdrawal is a highly individual and varying process. Furthermore, isn’t over 150 years of waiting enough? There has been no good evidence base either about how to come off opium, morphine, bromides and barbiturates.

I shall not repeat the extensive advice I gave in another book about drug withdrawal,^8:93 only repeat a few things and add some more.

The patient needs a support person during withdrawal. It is rare that such a person can be a doctor, as most doctors expose their patients to cold turkey withdrawal and then conclude that the patients still need the drugs. But it is a good idea to inform the usual doctor that a withdrawal is about to start and hopefully get the doctor interested in helping out. Automatic renewal of prescriptions over the phone should not occur, as the risk is that drug treatment will continue for many years.

The patient should try to find a person who has succeeded with withdrawal, a recovery mentor, and involve that person in the withdrawal.

Psychologists can be very helpful. It can be overwhelming when the emotions, which have been suppressed for so long, come back, and in this phase, it can be crucial to get psychological support to handle the transition from living emotionally numbed to living a full life.

A health professional or recovery mentor will rarely be able to support a patient on a daily basis. Other support people are needed, which can be relatives or friends.

It is often huge work to help a patient get through withdrawal, and it doesn’t end there. The support person should wrap it all up together with the patient and summarise the withdrawal process, including the most important symptoms experienced along the way. The patient should be offered continued support, as there is a risk that the patient would want to come back on the drug if a situation is stressful, which can cause some of the withdrawal symptoms to return, even long after a successful withdrawal. It can take many years before the brain becomes normal again.

The patient needs to know that the support person will always be available, and the feeling of security and that someone cares can have a strong healing effect.

One should not try to taper off a patient who doesn’t have a genuine wish of becoming drug-free. It is unlikely to work. But this should not be used as an excuse for doing nothing. We need to explain to the patients that long-term treatment is very harmful and we should try to persuade the patients to start a withdrawal process.

With three experienced colleagues, I have written a short guide to psychiatric drug withdrawal, with tips about how to divide tablets and capsules. We also made an abstinence chart that allows the patient to follow the symptoms over time, and I have provided a list of people willing to help with withdrawal and links to videos of our lectures on withdrawal.⁶¹³ There are many websites set up by psychiatric survivors^8:198 that offer good guidance, e.g. theinnercompass.org, created by Laura Delano who lost 14 years to psychiatry^7:298 but reclaimed her life after she had read Whitaker’s famous book, Anatomy of an Epidemic.⁵

In Holland, former patient Peter Groot and psychiatrist professor Jim van Os have taken a remarkable initiative. A Dutch pharmacy produces tapering strips, with smaller and smaller doses of the drug, making it easier to withdraw. Their results are also remarkable. In a group of 895 patients on depression pills, 62% had previously tried to withdraw without success, and 49% of them had experienced severe withdrawal symptoms (7 on a scale 1 to 7).⁶¹⁴ After a median of only 56 days, 71% of the 895 patients had come off their drug.

Each strip covers 28 days and patients can use one or more strips to regulate the dose reduction. There is a website dedicated to this, taperingstrip.org. People in other countries currently try to convince pharmacies to produce tapering strips.

It is important to get a successful start. It is often best to remove the most recently started drug,¹³⁵ as withdrawal gets harder the longer the patient has been on a drug.^135,614 It is also important to withdraw psychosis pills and lithium early on, as they cause many harms.¹³⁵ Withdrawal can cause sleeping problems, which is a good reason to remove sleep aids last.

It is not advisable to withdraw more than one drug at a time, as it makes it difficult to find out which drug causes the withdrawal symptoms.

It is rarely a good idea to substitute one drug for another, even if the new drug has a longer half-life in the body and would be expected to be easier to work with. Some doctors do this, but a switch can lead to additional withdrawal problems because the two drugs may not target the same receptors, or to overdosing, as it is hard to know which doses should be used for the two drugs in the transition phase. But it may be necessary, e.g. if the tablet or capsule cannot be split.

It is generally not advisable to introduce a new drug, e.g. a sleeping pill if the withdrawal symptoms make sleep difficult. It is better to increase the dose a little.

The dose reduction must follow a hyperbolic curve. This means that you reduce the dose every time you taper by removing the same percentage of your previous dose. If you reduce the dose by 20% each time, and you have come down to 50%, you should remove 20% again next time, which means that you now come down to 40% of the starting dose.

One layperson withdrawal community found that the least disruptive taper is when you reduce the dose by 5-10% per month,⁶¹⁵ but I would not recommend this approach. If you reduce by 10% per month, it will take two years before you come down to 8% of your starting dose, so if you are on four drugs, it may take you eight years to become medicine-free. And the longer you take a drug, the greater the risk of permanent brain damage, and the harder it is to come off it.

The last small step can be the worst, not only because of physical issues but for psychological reasons. The patient may ask himself: “I have taken this pill for so long; dare I take the last small step? Who am I when I don’t take the pill?” The doctor may laugh and tell the patient that it’s impossible to have withdrawal symptoms when the dose is so low.⁶¹⁶ If that doctor is involved in the withdrawal and behaves like a “know-it-all” guy, the patient should find another doctor.

Citalopram is recommended to be used at dosages of 20 or 40 mg daily, and it will surprise any doctor to know that even at a dose as low as 0.4 mg, 10% of the serotonin receptors are still being occupied.²⁸¹ This means that the patient might experience withdrawal symptoms when going from that small dose to nothing. Psychiatrist Mark Horowitz admitted that if the patients had come to him before he had experienced the withdrawal symptoms himself, he would probably not have believed them when they said how difficult it was coming off a depression pill.⁶¹⁶

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 15: Withdrawal of Psychiatric Drugs appeared first on Mad In America.

There wasn’t much mention in the textbooks of an independent role of psychologists in mental health. Psychotherapy was often listed as an option, but almost always in a context that also involved drugs. It was implicitly understood that even psychotherapy was the responsibility of psychiatrists. When reading the books, I did not doubt that the psychiatrists had won the decades old battle with the psychologists and had absolute power over everything in mental health.

It was almost as if the psychological profession did not exist. When anything was specifically mentioned in relation to psychologists, they were reduced to being servants of the psychiatrists.

This was particularly clear in the textbook about child and adolescent psychiatry.¹⁹ All the editors were psychiatrists and they protected their guild. The book started out by saying that children and young people with mental disorders must be referred to a child and adolescent psychiatrist if there is psychopathology and the problem is too complicated for general practitioners or social workers.^19:13 There was nothing about which help psychologists can offer and the advice contained a pleonasm: If a person has a mental disorder, there is psychopathology, which is just another name for the same thing.

Psychologists were mentioned only as testers.^19:15,19:25 They test the cognitive level and attention and do projective tests like the Rorschach test where the patients are shown a series of irregular, symmetrical inkblots and explain what they see.

It was noted that the first clinical assessment could be made by a general practitioner, in healthcare, at a paediatric ward or in an emergency room.^19:14 Psychologists were not mentioned but referrals could also come from school psychologists. And older children and young people could take the initiative themselves, for example by contacting a psychologist.^19:14 However, many parents take their children, also young ones, to a psychologist and would never contact a psychiatrist as the first step. In one of my books, I write:^8:4

“If you have a mental health issue, don’t see a psychiatrist. It is too dangerous and might turn out to be the biggest error you made in your entire life.”⁵⁹⁷ The quote is from Peter Breggin, a psychiatrist who avoids using drugs. As noted on the first page in this book, the public knows very well that there is a great risk that they or their children will be harmed if they contact psychiatry.¹²

In 1992, the UK Royal College of Psychiatrists, in association with the Royal College of General Practitioners, launched a five-year Defeat depression campaign.^8:1,494 Its aim was to provide public education about depression and its treatment in order to encourage earlier treatment-seeking and reduce stigma. Campaign activities included newspaper and magazine articles, television and radio interviews, press conferences, production of leaflets, factsheets in ethnic minority languages, audio cassettes, a self-help video and two books.⁵⁹⁸ The colleges had accepted donations from all the major manufacturers of depression pills for the campaign, and the president of the Royal College of Psychiatrists, Robert Kendall, acknowledged that their motive was to sell more pills.^8:2

When 2,003 lay people were surveyed before the launch of the campaign, 91% thought that people with depression should be offered counselling; only 16% thought they should be offered depression pills; only 46% said they were effective; and 78% regarded them as addictive.⁴⁹⁴

The psychiatrists replied pompously: “Doctors have an important role in educating the public about depression and the rationale for antidepressant treatment. In particular, patients should know that dependence is not a problem with antidepressants.” I fully understand why the survey also found that “the word psychiatrist carried connotations of stigma and even fear.”

It’s not the patients that need training, it’s the psychiatrists and other doctors that prescribe psychiatric drugs, but they are so much out of touch with reality that no amount of training will get them close to where the patients and the general public want them to be.

There is also institutional corruption.⁵⁹⁹ Just before fluoxetine (Prozac) reached the market in 1988, NIMH surveyed the public about its views on depression, and only 12% wanted to take a pill to treat it.^5:290 However, the NIMH was determined to change this attitude and launched a public awareness campaign claiming that depression is a serious disease that can be fatal if untreated; depression is underdiagnosed and undertreated; and 70-80% get better on drug and only 20-40% on placebo. The postulated 45% difference in effect is fraudulent; even the FDA found only 10% in flawed trials,³⁰³ and the patients do not get better on drugs. They get worse, which is why 12% more patients leave the trials when they are on drug than when they are on placebo.³⁰¹ The campaign was immensely successful, and the media praised Prozac as the new wonder drug.

A chapter on psychotherapy written by a psychologist, professor Nicole Rosenberg, was unusually well documented. She wrote that cognitive behavioural therapy has a small effect in schizophrenia; is effective against depression, also in preventing relapse and in getting people back to work; and works for anxiety, with large effects for generalised anxiety, social phobia and post-traumatic stress disorder (PTSD).^16:597

This is important information, particularly that psychotherapy can get depressed people back to work. It has never been documented that depression pills have such an effect, and they seem to have the opposite effect. The rate of disability pensions follows the usage rates for psychiatric drugs,^5:8,119:24 and most of these drugs are depression pills.⁷

Rosenberg mentioned many names in the text, e.g. a Cochrane review by Niewenhuijsen, a 2006 meta-analysis by Butler, and a 2007 meta-analysis by Norton and Price of 108 studies, but many of the papers didn’t appear in the literature list, which only had 16 references.

Textbook authors should not play hide and seek with the readers about important statements. It is often difficult, and sometimes impossible, to find the papers.

I found three Cochrane reviews with Niewenhuijsen as author. One was about interventions to improve return to work in depressed people, published in 2012 and updated in 2020.⁶⁰⁰ It found moderate quality evidence based on three studies that telephone or online cognitive behavioural therapy was more effective in reducing sick leave than usual primary or occupational care, effect size -0.23 (-0.45 to -0.01). In the 2020 update, there were more studies of psychotherapy, and the effect was now -0.15 (-0.28 to -0.03).⁶⁰¹

When I searched on Butler in the author field, 2006 in the publication year field, and meta-analysis in the title field, there were no records on PubMed. People named Butler had published 663 articles in 2006, but only 161 had Butler as first author. Sorting these by best match yielded a review of meta-analyses as the top record.⁶⁰²

The authors had reviewed 16 methodologically rigorous meta-analyses and reported that the effect sizes for cognitive behavioural therapy were large for unipolar depression, generalised anxiety disorder, panic disorder with or without agoraphobia, social phobia, posttraumatic stress disorder, and childhood depressive and anxiety disorders, and that the effect of cognitive behavioural therapy was somewhat superior to depression pills in the treatment of adult depression.

When I searched on Norton as I had done for Butler, there were no records, but after having tried various strategies, I found “a meta-analytic review.”⁶⁰³ It included 108 trials of cognitive behavioural therapy and reported that this therapy and exposure therapy—alone, in combination, or combined with relaxation training—were efficacious for anxiety disorders, which included generalised anxiety disorder, posttraumatic stress disorder and social phobia.

The aim of psychological treatments is to change a brain that is not functioning well back towards a more normal state.^8:89 Psychiatric drugs also change the brain, but by creating an artificial third state—an unknown territory—that is neither normal nor the malfunctioning state the patient came from.⁶⁰⁴

This is problematic because you cannot go from the chemically induced third state back to normal unless you taper off the drugs, and even then, it will not always be possible, as you might have developed irreversible brain damage.

A humane approach to emotional pain is very important, and treatment outcomes depend more on therapeutic alliances than on whether psychotherapy or pharmacotherapy is used.⁶⁰⁵ Furthermore, the more in agreement physicians and patients are about what is important when

being cured from depression, the better the outcomes for positive affect, anxiety and social relationships.⁶⁰⁶

Most of the problems patients face are caused by maladaptive emotion regulation. Psychiatric drugs make matters worse, as their effects constitute exactly this, maladaptive emotion regulation.⁶⁰⁷ In contrast, psychotherapy aims at teaching patients to handle their feelings, thoughts and behaviour in better ways, which constitutes adaptive emotion regulation. It may permanently change patients for the better and make them stronger when facing life’s challenges.

In accordance with this, meta-analyses have found that the effectiveness of psychotherapy compared with depression pills depends on the length of the trial, and psychotherapy has an enduring effect that clearly outperforms pharmacotherapy in the long run.^497-501,503 In one meta-analysis, the effect size was 0.26 (P = 0.003).⁴⁹⁸ In another meta-analysis, there was a trend toward better long-term effect of acute psychotherapy compared with ongoing pharmacotherapy, odds ratio 1.62 (0.97 to 2.72).⁴⁹⁹ As in other meta-analyses, there were also more dropouts in the acute phase on drug than on psychotherapy, odds ratio 0.59 (0.34 to 0.99). The patients are better helped by psychotherapy, which is also what they prefer but rarely get (see Chapter 8, Part Fourteen).^494-496

Short-term results are misleading. We should only take results into consideration if they have been obtained after at least a year. We also need to consider that trials that have compared psychotherapy with drugs are not effectively blinded, neither for psychotherapy nor for drugs. The prevailing belief in the biomedical model would be expected to influence the psychiatrists’ behaviour during the trial and to bias their outcome assessments in favour of drugs over psychotherapy.

Trials that show that the effects of a drug and psychotherapy combined are better than either treatment alone should also be interpreted cautiously, and I will not advocate the combination. Providing effective psychotherapy can be difficult when the patients’ brains are numbed by psychoactive substances, which may render them unable to think clearly or to evaluate themselves. As noted earlier, the lack of insight into feelings, thoughts and behaviours is called medication spellbinding.^135,159 The main biasing effect of medication spellbinding is that the patients underestimate the harms of psychiatric drugs, which they have gotten used to.

In June 2022, I witnessed a PhD defence in Copenhagen.⁶⁰⁷ One of the examiners, a psychologist, made a lot out of saying that psychotherapy wasn’t any better than drugs for depression. It provoked me so much that – when I was allowed to comment after the defence was over – I noted that it was not appropriate to refer to short-term results obtained with the Hamilton rating scale when comparing the two treatments because this ignores that psychotherapy does not cause withdrawal symptoms or destroy people’s sex lives; that pills cannot teach patients anything which psychotherapy can; and that pills double the risk of suicide whereas psychotherapy halves this risk.²⁷²

The examiner did not reply, but the other examiner, a psychiatrist, noted that psychotherapy does not always work and when the patients come to him, they have already tried it in vain. This reply is typical for psychiatrists. But pills that do not have clinically relevant effects and double the risk of suicide, the most feared outcome of a depression, cannot be legitimised this way.

I shall not go into detail about psychotherapy. There are many methods and schools, and it is not so important which method you use. It is far more important that you are a good listener and meet your fellow human being where he is, as Danish philosopher Søren Kierkegaard advised us to do two centuries ago. As there are many trials with cognitive behavioural therapy, this tends to be the preferred method, but if used too indiscriminately, it can be a sort of cook-book approach that pays too little attention to the concrete patient’s special circumstances, wishes and history.

Psychotherapy seems to be useful for the whole range of psychiatric disorders including psy-choses^7,253 (see also earlier chapters). It does not work for everyone. But this should not make us use inefficacious and harmful drugs. Some people cannot be helped no matter what we do, also in other areas of healthcare. We cannot help most patients with cancer and use chemotherapy far too much out of desperation,⁴⁶ ruining people’s lives, rushing them in and out of hospital, instead of giving them a peaceful time with their loved ones without drugs.

Physical and emotional pain have similarities. Just like we need physical pain to avoid dangers, we need emotional pain to guide us in life.⁵⁹¹ According to a Swedish psychiatrist who does not use drugs, we learn something important through the process of healing that can be useful if we get in trouble again, which can boost our self-confidence. In contrast, doctors may think they need not engage themselves as much when a patient is taking drugs.⁵⁹¹

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 14: Psychotherapy and the Role of Psychologists appeared first on Mad In America.

The textbooks were rather silent about this important issue, which is remarkable, as forced treatment is highly controversial.^7:314

As power corrupts, there needs to be a power balance in human relations. However, involuntarily admitted patients are powerless. This extreme power imbalance is a recipe for disaster, and there is nothing psychiatric patients fear more than forced treatment. Some psychiatrists have administered electroshocks to the patients they disliked the most, and doctors have regularly prescribed shocks for those patients who were fighting, restless, noisy, quarrelsome, stubborn and obstinate.^1:106

There is a high risk that forced treatment is being used to benefit staff rather than patients to make their work less stressful, which is the major reason for the popularity of psychosis pills when they appeared in the 1950s.¹ In Europe, the oversight of forced treatment comes under the convention prohibiting torture, and a committee has observed that deliberate ill-treatment of patients in psychiatric establishments still occurs.⁵⁸³

I have provided a long account of the abuses in another book^7:314 and shall only comment on a few issues here.

The European Committee for the Prevention of Torture has noted that, on inspection, it all too often finds that fundamental components of effective psychosocial rehabilitative treatment are underdeveloped or totally lacking, and that the treatment consists essentially of drugs.

The laws about forced treatment are highly problematic. In many countries, a person considered insane, or in a similar condition, can be admitted to a psychiatric ward on an involuntary basis if the prospect of cure or substantial and significant improvement of the condition would otherwise be significantly impaired.

Are there any treatments that can cure insane patients or lead to such substantial improvements that the patient’s condition would be significantly impaired if she is not forced to go to hospital immediately? I don’t think so, and, considering the abuse that takes place at psychiatric wards, this clause should be removed from the law of all nations, also because its premise is false.

The other lawful reason for forcing drugs on people is if they present an obvious and substantial danger to themselves or others. This is also an invalid argument. Psychiatric drugs cause suicide and violence^7,8 and they cannot protect against violence unless the patients are drugged to such an extent that they have become zombies. According to the National Italian Mental Health Law, a reason for involuntary treatment cannot be that the patient is dangerous. This is a matter for the police.

Rare cases like forced feeding for life-threatening anorexia are already covered by other laws than those that apply specifically to psychiatry. And severe mania where the patient may be busily spending his entire wealth can also be handled without forced hospitalisation and treatment. For example, an emergency clause could be introduced that removes the patients’ financial decision-making rights at short notice. Furthermore, a few difficult cases cannot justify that massive harm is inflicted on the patients in general,⁷ which also makes it difficult to recruit good people to psychiatry. No one likes coercion, and it destroys the patient’s trust in the staff, which is so important for healing and for the working environment in the department.

Some patients have found that they should avoid mentioning certain things to their psychiatrist when hospitalised because it may lead to additional diagnoses and more medication, which the psychiatrist will rarely be interested in stopping again.

What should a patient do if she is convinced that the drug and not the disease is the cause of her symptoms? If she says anything about having the dose reduced, she might end up having it increased, or having another drug prescribed on top of the current one, with the argument that she lacks insight into her disease. Many of the about 1000 emails I have received from patients and relatives describe exactly this.

As for all interventions in healthcare, the overriding question is whether forced treatment does more good than harm. I have no doubt it does vastly more harm than good and that we will never be able to prevent the widespread abuse if we keep it. There are no randomised trials that have compared the use of force with no use of force but we know enough already. Mechanical restraint and ECT can be fatal; and, as explained earlier, psychosis drugs, other psychiatric drugs, and contact with a psychiatric ward kill an enormous amount of people.

One of psychiatry’s unfortunate fads is community treatment orders, often called assisted outpatient treatment in the United States, which are legal regimes making outpatient treatment compulsory. A 2014 Cochrane review didn’t find any differences in service use, social functioning or quality of life compared with voluntary care or brief supervised discharge.⁵⁸⁴ In clinical practice, this initiative has also failed. After the UK had introduced these treatment orders, hospital admissions increased.⁵⁸⁵ Another problem has been the great variation in their use, with some areas discharging 45% of the patients with treatment orders and others none at all. Some psychiatrists find treatment orders unethical and many patients find them stigmatising.

In 2007, the UK mental health charity, Mind, expressed many concerns.⁵⁸⁶ If a community patient’s distress is manageable, the professionals may well argue that the set-up is working and should be continued, but at what point will it be stopped? Without the natural cap on hospital detention provided by the finite number of beds, these orders will be used for too long and for too many people, like a “lobster pot”—easy to get into but very difficult to ever get discharged from. Community treatment orders mean that many people who do not wish to take drugs for the rest of their lives are no longer able to make that decision. There is no escape from this Catch-22. If the patient remains well, this is taken to mean that the drugs are working, and if not, forced drugging is often increased, causing even more misery and more deaths. Many people consulted by Mind felt their relationships with professionals would be harmed by the increased threat of compulsion, with those professionals being turned into “Mental Health Act police officers.”

The therapeutic relationship is what matters the most, and if you have been a cop and have used force, it becomes nearly impossible to change that role into the role of the physician as a healer and advocate for the patient.^7:327 This is why psychiatrists should stay out of the job of being police. Another reason is that violence breeds violence. Loren Mosher testified in a Supreme Court case in Alaska and reported that in his whole career he had never acted as a police officer. He formed the kind of relationship and an ongoing treatment plan, which was acceptable both to him and the patient, and which avoided their getting into a fight.

Lawyer Jim Gottstein convinced the court to rule that the government cannot drug someone against their will without first proving by clear and convincing evidence that it is in their best interests and there is no less intrusive alternative available. Gottstein used scientific data to prove that it was not in the patients’ best interest to treat them forcefully.^7:328

Psychiatrists usually say that it would be impossible to practice psychiatry safely without having the option of using forced drugging, restraints with belts and straps, and seclusion. But this is false. Studies have shown that, with adequate leadership and training of staff in de-escalation techniques, it is possible to practice psychiatry without using force.^587,588

Psychiatrists should consider that some patients don’t tell them about their thoughts, how they feel, and what they experience, because they are afraid that if they are honest, it could lead to forced treatment. This is not a healthy therapeutic relationship and reminds us of the living conditions in concentration camps where it is important to never provoke the guards, which will lead to harsh punishment.

It is not laudable either that the staff often “justify” their actions by saying that, were it not for the forced treatment, the patient might have died. The evidence tells us the opposite; forced treatment kills patients.⁷ A patient told me that she likened forced treatment to rape and that there cannot be good rapes. This patient was raped by a man in her family when she was only nine years old and became terrified when the staff subjected her to forced treatment.

When I lectured in Australia in 2015, I was told that only 3-5% of the patients come off the treatment orders again and I met with a doctor who had been on such an order on and off for 20 years. He gave me a copy of an evaluation by a psychiatrist who in 1995 deemed him insightless because he had alerted the community to the brain-damaging effect of psychosis drugs! Another person I met was a psychiatrist who was considered insane by her colleagues, also because she spoke out about psychiatric drug harms. They tried to have her involuntarily confined to hospital but failed.

In 2014, the Danish Ministry of Health issued a licence to kill. It allowed psychiatrists to use extraordinarily large doses of psychosis drugs for forced treatment and said that this applies especially to patients who have been in prolonged treatment and where smaller doses have been tried without a good therapeutic result.⁵⁸⁹ It’s insane. These patients should have their drug withdrawn. Giving more of what was already not working doesn’t help, it kills.

Since forced treatment is not evidence-based but culture-based, it is no surprise that practices vary enormously between countries. Involuntary hospital admissions in Europe range from 12 per 100,000 inhabitants in Italy to 233 in Finland.⁵⁸⁷ Once admitted, rates of coercion also vary enormously. In Austria, mechanical restraint is used 45 times more often than in the Netherlands, where forced drugging is also used very little.⁵⁹⁰

The fundamental human right to equal recognition before the law applies to everyone, also to people with mental disorders. This is clear from the Universal Declaration of Human Rights, the International Covenant on Civil and Political Rights and the United Nations Convention on the Rights of Persons with Disabilities, which has been ratified by virtually all countries.¹⁸⁴

In 2014, the Convention specified that member states must immediately begin taking steps towards the realisation of the rights by developing laws and policies to replace regimes of substitute decision-making by supported decision-making, which respects the person’s autonomy, will and preferences. At all times, the individual autonomy and capacity of persons with disabilities to make decisions must be respected, which means that “mental health laws that permit forced treatment must be abolished.”

The Convention makes it clear that “unsoundedness of mind” and other discriminatory labels are not legitimate reasons for the denial of legal capacity, and that the concept of mental capacity is highly controversial in and of itself.^7:335

Everyone who argues for forced treatment and involuntary detention should read a heartbreaking book, Dear Luise, ²³⁴ which I have summarised^7:337 and briefly mentioned in Chapter 7, Part Five.

In his foreword, “You need to be strong in order to be vulnerable,” former Danish Prime Minister Poul Nyrup Rasmussen describes the book as heart-breaking. It truly is. It could be used as a screening test for doctors who contemplate to become psychiatrists. If they get through it without crying, they should find themselves another job.

Luise’s best friend at the care home, who stayed in the room next to her, suddenly collapsed at the floor and died within a few minutes. Luise was completely shattered and all she said to her mother was: “I’ll be next,” which she became six months later. She and her mother protested against her treatment. The psychiatrist didn’t care and killed her with a depot injection.^7:337

The level of ignorance and the lack of respect for Luise and her mother who knew a lot about the drugs was astounding. Luise’s mother did everything she could to prevent Luise from being overdosed and begged the staff not to overdose, but Luise died from an overdose.

When Luise’s mother complained to the authorities after the death, the system replied that Luise had received the highest standard of specialist treatment while it congratulated itself with its first-class homicide which they called a “natural death.” Many relatives have experienced that psychiatrists killed their loved ones, and in Denmark they have united in the association Death in psychiatry, which demonstrates in front of the hospital every year on Luise’s death day.

The book, which has been translated into English,²³⁴ describes virtually everything that is wrong with psychiatry including making incorrect diagnoses. Whenever I open it again, I get overwhelmed with sadness because I know the author and also that many psychiatric patients are abused and die under similar circumstances as Luise and her best friend. Luise was a slow metaboliser, and her mother had begged the psychiatrists never to use a depot injection, which was what killed her daughter.

Being treated humanely is difficult in today’s psychiatry. If you panic and go to a psychiatric emergency ward, you will probably be told you need a drug, and if you decline and say you just need rest to collect yourself, you might be told that the ward is not a hotel.⁵⁹¹

This is bad medicine. Impending psychoses can sometimes be fended off before they develop if we provide patients with the shelter and rest they need. There should be 24-hour support facilities without any compulsion, so that the hospital is no longer the only place patients in acute crisis can go to.⁵⁹² There could be refuges with the possibility of accommodation and the money should follow the patient and not the treatment.

Psychiatry seems to be the only area in society where the law is systematically being violated all over the world—even Supreme Court and Ombudsman decisions are being ignored.^{8:328,593,594}

We studied 30 consecutive cases from the Psychiatric Appeals Board in Denmark and found that the law had been violated in every single case.^594,595 All 30 patients were forced to take psychosis pills they didn’t want, even though less dangerous alternatives could be used, e.g. benzodiazepines.¹⁶⁵ The psychiatrists had no respect for the patients’ views and experiences. In all 21 cases where there was information about the effect of previous drugs, the psychiatrists stated that psychosis pills had had a good effect whereas none of the patients shared this view.⁵⁹⁵

The harms of prior medication played no role either in the psychiatrist’s decision making, not even when they were serious, e.g. we suspected or found akathisia or tardive dyskinesia in seven patients, and five patients expressed fear of dying because of the forced treatment. An expert confirmed our suspicion that a patient had developed akathisia on aripiprazole (Abilify) but on the same page, the expert—a high-ranking member of the board of the Danish Psychiatric Association—recommended forced treatment with this drug even though it was stopped because of the akathisia.⁵⁹⁵

The power imbalance was extreme. We had reservations about the psychiatrists’ diagnoses of delusions in nine cases, and there is an element of Catch-22 when a psychiatrist decides on a diagnosis and the patient disagrees. According to the psychiatrist, the disagreement shows that the patient has a lack of insight into the disease, which is a proof of mental illness. The abuse involved psychiatrists using diagnoses or derogatory terms for things they didn’t like or didn’t understand; the patients felt misunderstood and overlooked; their legal protection was a sham; and the harm done was immense.⁵⁹⁵

The patients or their disease were blamed for virtually everything untoward that happened. The psychiatrists didn’t seem to have any interest in traumas, neither previous ones nor those caused by themselves or their staff. Withdrawal reactions were not taken seriously—we didn’t even see this term, or a similar one, being used although many patients suffered from them.

It is a very serious transgression of the law and of professional ethics when psychiatrists exaggerate the patients’ symptoms and trivialise the harms of the drugs to maintain coercion, but this often happens, and the patient files can be very misleading or outright wrong.^{7,121,234,595} In this way, the psychiatrists can be said to operate a kangaroo court, where they are both investigators and judges and they routinely lie about the evidence,^7:329 where after they sentence the patients to a treatment that is deadly for some of them and harmful for everyone.

In Denmark, when the patients complain about this unfair treatment, which isn’t allowed in any other sector of society, it is the same judges (or their friends that won’t disagree with them) whose evidence and judgments provide the basis for the verdicts at the two appeal boards, first the Psychiatric Patients’ Complaints Board, and next, the Psychiatric Appeals Board. It doesn’t matter the slightest bit what the patients say. As they have been declared insane, no one finds it necessary to listen to them. This is a system so abominable that it looks surreal, but this is the reality all over the world.

In one of the textbooks, under the section, “The Violent and Aggressive Patient,” the authors mentioned some drugs that, in rare cases, can cause motor restlessness and increase restlessness and aggression. These drugs are benzodiazepines, amphetamine, anabolic steroids, and testosterone.^17:821

It is inexcusable that the authors did not mention that depression pills, methylphenidate and psychosis pills can also cause such symptoms and did not mention akathisia either, one of the most dangerous drug harms. This is yet another example that psychiatrists protect their guild.⁵⁹⁶

Further ahead, the authors noted that studies suggest that the patients’ aggression can be seen as a reaction to conflicts among the staff, and they said that a newer study pointed out that increased patient autonomy can reduce violent behaviour and the use of coercion.^17:828 We all know it can reduce aggression to respect other people. This is what international diplomacy is about, and no scientific studies are needed to confirm this.

However, the respect for the patients lasted only one page. On the next page, we are told that not using psychotropic drugs for patients that are agitated, aggressive or violent and where belt fixation might be needed should only occur exceptionally and then accompanied by a clear argumentation for this in the patient file. A table with suggested interventions included lorazepam, olanzapine, ziprasidone or haloperidol in the acute phase, and clozapine, antiepileptic drugs, depression pills, or ECT in the follow-up phase. This is a prescription for death and for creating zombies.

The book mentioned the rule about using the least intrusive treatment, but then argued that some patients are permanently incompetent, i.e. permanently lack the ability to consent, and that these include mentally ill people with mental disabilities, chronic mentally ill people, and mentally ill people with long-term illnesses, and that the issue is whether the patients can give a reasonably meaningful informed consent.^17:927 As noted above, these arguments have been rejected by the United Nations Convention on the Rights of Persons with Disabilities.¹⁸⁴

The same book had a section about forensic psychiatry where it was argued that randomised trials studying the effects of using force cannot be carried out for ethical reasons.^17:926 This is wrong. There are good intentions behind using force in psychiatry, but the harms are massive, and it is not at all clear if force, on average, benefits or harms the patients. Most likely, it is harmful. Therefore, it is ethically acceptable to do randomised trials. During a trial, half of the patients will avoid coercion, and when the trial is over, perhaps all future patients will avoid coercion. What is unethical is to continue subjecting patients to force against their will.¹⁸⁴

The book argued that, during forced treatment, one should only use medication in usual doses and with the fewest possible harms.^17:929 This contradicts what other authors wrote in the same book 277 pages earlier, that it is appropriate in some cases to increase the dose of psychosis drugs above the approved interval.^17:652

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 13: Forced Treatment appeared first on Mad In America.

Unfortunately, like most successful grassroots organisations, it came to suffer from institutional corruption early on. This moral decline accelerated when a new CEO, journalist Mark Wilson, was appointed in 2012. I co-founded Cochrane in 1993 and have described its moral and scientific downfall in two books. This sad story will also be told in a documentary and in my upcoming podcast series, Broken Medical Science.

Cochrane reviews are published in the Cochrane Library, once at the forefront of science, but now an anachronism, as is Cochrane’s marketing logo, “Trusted evidence.” This is particularly true with Cochrane reviews of psychiatric treatments; they can’t be trusted.

Today, Cochrane is keen to protect guild interests and to comply with official views from governments even when they contradict the evidence in Cochrane reviews, as illustrated by its recent review of face masks. Cochrane is too close to industry, and Cochrane does not care much about financial conflicts of interest for its review authors.

When I was elected to the Cochrane Governing Board in 2017, I called for a strengthening of our conflicts of interest policy. This was agreed to, and I rewrote the policy in an afternoon. But the Cochrane leadership ignored it and spent over two years consulting with Cochrane members before its “strengthened” policy came out. Today, 33% of new review authors can be on company payroll. Before, it was 50%. Semmelweis would not have liked this “revolutionary” new policy. He never told doctors to reduce contamination by washing one hand. He told them to wash both hands.

The game for Cochrane seems to be over. Cochrane’s CEO Mark Wilson showed no interest at all when, a decade ago, Tom Jefferson demonstrated that Cochrane reviews of drugs against influenza based on published trial reports are totally misleading. I demonstrated that this was also the case for psychiatric drugs. Wilson suddenly left Cochrane in the middle of a month, in April 2021, with no explanation, seven days before the UK funder announced that a major budget cut was likely. The current leadership shows no interest either in this vitally important issue of whether its reviews are misleading.

In April 2021, Professor Ken Stein, Director of the Evidence Synthesis Programme at the UK National Institute for Health and Care Research (NIHCR), the major funder of Cochrane, criticised Cochrane at a webinar for much the same reasons as I had when I joined the Cochrane Governing Board. He said the writing had been on the wall for eight years, which was exactly the period when Mark Wilson ruled the organisation and destroyed it.

About the failing scientific integrity, Stein noted that, “This is a point raised by people in the Collaboration to ensure that garbage does not go into the reviews; otherwise, your reviews will be garbage.” And as Tom Jefferson said in an interview in 2018, such reviews are published with a nice little Cochrane logo on the garbage.

There were, at the start of 2023, 52 Cochrane review groups in the world, together covering all aspects of healthcare. However, in March 2023, all 24 with a base in the UK lost their government funding. Apart from four groups that have other funding sources, they have all now closed down. In July 2023, the NIHCR announced that it will end its contract with the UK Cochrane Centre in March 2024, a year before it was due to expire. The reason? Inefficiency and lack of relevance of the Cochrane reviews.

Cochrane has become a self-serving institution, a hugely ineffective bureaucracy, which is succumbing under its own weight, as illustrated by the size of Cochrane reviews. The median size was 26 pages in 2001, 41 in 2012 and 79 in 2023. A few  are so big that they correspond to several books.

If you have a collection of, say, 30 drug trials that are all deeply flawed, which is typically the case in psychiatry, you are not allowed to say this in a short review. Instead, you are required to write a very long review with details about every single trial even though it is impossible to conclude anything based on them. Yet, even given this meticulous attention to detail, most Cochrane authors and editors pay far too little attention to all the flaws in the trials and draw conclusions about drug benefits and a lack of harms that are unjustified.

Cochrane reviews of psychiatric drugs should generally be ignored. Virtually all of them are based on untrustworthy published trial reports, rather than on the lengthy clinical study reports the manufacturers have submitted to drug agencies to get approval for their drugs. In particular, reviews of placebo-controlled trials are a garbage in, garbage out exercise.

Cochrane editorial misconduct in relation to our review of safe withdrawal of depression drugs

In 2016, I contacted psychiatrist Rachel Churchill, editor of the Cochrane Common Mental Disorders group, who showed great interest in my proposal to do a review on safe withdrawal of depression drugs. The story of how Cochrane treated this proposal provides a case study of how Cochrane protects guild interests.

This was a very important review. Hundreds of millions of patients have become dependent on depression drugs, just like patients become dependent on benzodiazepines. The withdrawal symptoms are very similar; about half have difficulty stopping; and doctors don’t know how to taper the drugs safely and therefore usually just renew the prescriptions, for many years on end.

But we quickly faced a roadblock. The Cochrane group was extremely slow to respond and imposed ever increasing demands to our protocol. At the same time, they negotiated secretly with another author group on the same issue. This violated two of the ten Cochrane key principles: Collaboration, which involves open and transparent communication and decision-making, and avoiding duplication of effort, which is about avoiding that two reviews cover more or less the same ground.

The Cochrane group rejected our protocol two years and four months after we first submitted it, while it accepted the other authors’ protocol and published a very embarrassing Cochrane review, which is full of misleading statements and marketing messages of great value for the drug industry but irrelevant for doctors and patients (see below).

On 28 March 2023, I sent a complaint to Karla Soares-Weiser, Cochrane’s Editor-in-Chief, about editorial misconduct in an open letter. Later, I also sent a complaint to Cochrane’s current CEO, Catherine Spencer. I asked some simple questions, which they refused to answer. I have described the bizarre interactions I had with the Cochrane leadership elsewhere. Briefly, they beat about the bush, just like the drug industry does when you have a really good case against them. I couldn’t see the difference. As Jefferson once said in relation to Roche’s unwillingness to provide the data from its unpublished trials of Tamiflu for influenza, If you have nothing to hide, then hide nothing. Cochrane hid everything in relation to our review.

It also turned out that Cochrane has no mechanism for handling allegations of editorial misconduct in an impartial manner, something all reputable journals have. My translation of the message I got from Cochrane’s CEO was this: “We don’t give a damn. We are beyond reproach.”

Cochrane abused the peer review process to the extreme

Our protocol for reviewing drug withdrawal studies was rejected in November 2019. However, in February 2020, a similar protocol about withdrawing depression drugs was published in the Cochrane Library. It takes a very long time to get a Cochrane protocol approved and published, which means that this project must have been underway secretly for many months while the review group increased their demands regarding our protocol, which I see as an effort to wear us out without their being seen as uncooperative.

Cochrane abused the peer review process to the extreme. Four editors and three peer reviewers provided individual comments, and, including our replies to earlier comments, the peer review document took up 12,044 words, seven times the number of words in our original protocol. My co-author wrote to me that our review was quite simple and that we just wanted to help people who wished to come off their drugs, but we weren’t allowed to do so. He asked: “What kind of world is this?”

The 8^th peer review was as long as our protocol. It was clear to us that the final reviewer’s mission was to protect psychiatry’s guild interests, providing an excuse for the editor to reject our protocol. This was done by denying a long array of scientific facts; by using strawman arguments accusing us of things we had never claimed; and by requesting us to discuss issues that were totally irrelevant for our review and to insert text that was blatantly wrong.

In contrast to the 7 previous reviewers, this one was anonymous. We asked for the identity of the “hangman,” but this was not granted. I noted that very few changes to the protocol were needed and submitted a new version and a rebuttal with solid scientific arguments against the many errors and misguided opinions in the peer review, but this didn’t matter the slightest bit for Cochrane.

The 8^th peer review is one of the worst I have ever seen. I published a detailed account of it four years ago and shall only summarise the main issues here.

The reviewer accused us of “painting a picture” about antidepressants being “bad medications” to be avoided, which did not represent the scientific consensus, and wanted us to “Start with a statement as to why antidepressants are considered by the scientific community to be beneficial … in treating a broad range of highly disabling and debilitating mental health problems.” The reviewer found it “unscientific, and unacceptable in the context of the current evidence base” that we had not mentioned the beneficial effects. We responded that our review was not an advertisement for the drugs and that it was not relevant to discuss their effect in a review about stopping using them.

The reviewer believed that a chemical imbalance in the brain was the cause of depression and wanted us to write about this. We responded that our review was not the place for such discussions and that the hypothesis of a lack of serotonin being the cause of depression had been discredited by many convincing studies.

We were asked to explain the concept of ongoing prophylactic antidepressant treatment, “a well-accepted clinical strategy,” but this was outside the scope of our review. Furthermore, the randomised trials comparing maintenance therapy with drug withdrawal are seriously flawed by their cold turkey design. Some of the withdrawal symptoms in the placebo group mimic depression.

The reviewer wrote that we conflated relapse with withdrawal symptoms, which wasn’t true. But many psychiatrists do, which is a major reason why many patients are treated for decades or for life.

The reviewer argued that most people who had taken antidepressants for extended periods could stop safely without either rebound of the disease or withdrawal symptoms. This is untrue, which we had documented and referenced in our protocol. The UK Royal College of Psychiatrists reported in 2012 that 63% of 817 people who had stopped taking depression pills experienced withdrawal symptoms.

The reviewer wanted us to remove this sentence: “the patients’ condition is best described as drug dependence” arguing, with reference to the DSM-IV drug dependence criteria, that it is an unreasonable misappropriation of a term. We responded: “The official definitions of dependence are ridiculous and self-serving, in addition to serving the drug companies that have benefitted hugely from the false perception that only benzodiazepines cause dependence, not the SSRIs. Craving larger and larger doses as a criterion for dependence is absurd, as it means that no one who smokes 20 cigarettes every day is dependent on smoking cigarettes!”

The published Cochrane review of withdrawal was of poor quality and filled with industry-like marketing messages

While we were being blocked from conducting a drug withdrawal review for Cochrane, the other group that had submitted a protocol for doing so was given the green light to proceed, and in 2021 Cochrane published it. The review was restricted to adults with depression or anxiety, which is irrational. The drugs are used for many conditions, and the withdrawal symptoms are not dependent on why the drugs are prescribed or the age of the patient. Moreover, the review did not include trials comparing different withdrawal strategies, which we did, whereas it included many flawed studies comparing abrupt discontinuation (cold turkey design) with continuation. We only included trials that had at least one treatment arm that aimed to help patients withdraw from a depression drug.

The published Cochrane review included 33 studies (4995 participants). In our review, which we first published as a preprint (likely to come out in a medical journal soon), we included 13 studies (2085 participants). The Cochrane review is 209 pages (110,770 words), the length of a full book, 23 times as long as our review of 9 pages.

I studied the Background section in the Cochrane review, which, with its 4239 words, is longer than most scientific papers. It is full of irrelevant marketing messages and misleading statements, which I noted in my complaint to Cochrane about editorial misconduct.

It states that “Maintenance treatment is provided to prevent recurrence.” There is no mention that all maintenance trials are deeply flawed and that the patients’ withdrawal symptoms are erroneously interpreted as a relapse of the depression.

“Antidepressants have been shown to be efficacious in adults … (Cipriani 2018) … between seven and eight people needed to be treated with an SSRI … for one person to experience improvement.”

These praises of drug benefits are invalid. The effect on the Hamilton scale, a difference of 2 over placebo, also in Cipriani 2018 (an effect size of 0.30 corresponds to a Hamilton difference of 2.3), is far below what is clinically relevant, as the least difference on the Hamilton scale that can be detected is about 5-6.

I have shown why the number needed to treat (NNT) with a psychiatric drug to benefit one patient is largely an illusion. One reason is that more patients are harmed than those who benefit. When patients decide whether it is worthwhile to continue in a trial, they make a judgement on whether the benefits they perceive exceed the harms. Based on clinical study reports we obtained from drug regulators, we found that 12% more patients drop out on a depression pill than on placebo (P < 0.00001). Thus, the patients consider placebo more useful than a depression drug, which means there cannot be an NNT, only a number needed to harm (NNH). Our meta-analysis showed that this number is about 25. The published trial reports do not reveal this devastating finding.

When the top among UK psychiatrists in 2014 tried to convince their readers that depression pills are highly effective, they mentioned an impressive effect on recurrence, with an NNT of around three. But these trials did not assess recurrence but withdrawal symptoms in the placebo group. As only two patients are needed to get one with withdrawal symptoms when a drug is stopped, there cannot exist an NNT to prevent recurrence, only an NNH, which is two.

Since depression pills harm the sex life in about half the patients, the NNH is two. Thus, by not using depression pills, we will preserve the normal sex life in one out of every two patients we do not treat.

The published Cochrane review is unbalanced. It gives precise but misleading estimates of the benefit in the form of NNT but does not offer similar estimates for the most serious harms. This goes against the very ethos of Cochrane, which always was to focus similarly on the benefits and harms of interventions. The Cochrane review mentions the worst harm, suicidality and suicide, in many places, but it does not say that depression drugs double the suicide risk, both in children and adults.

The Cochrane review states that “evidence suggests that continuation of antidepressant treatment is effective, as it reduces risk of relapse and recurrence by 50% to 70%.” The authors should not have propagated this horrible misinformation, but rather should have stated that there is no reliable evidence that the drugs reduce recurrence.

The review continues: “The effect of most antidepressants fully develops after some weeks, indicating that neurophysiological changes in brain tissue … are necessary for improvement in depressive symptoms.” This neuro mumbo jumbo is also highly misleading. One cannot say that the effect fully develops after some weeks when there is a very gradual and slow separation of the Hamilton scores on drug and on placebo and when the effect even after seven weeks is so small that it is not clinically relevant:

The authors note that “suggesting that a single biochemical deficiency is the cause of depression and that antidepressants work by correcting chemical deficiency is not correct.” Interesting that they were allowed to say this. We were heavily criticised by the hangman for having written that the hypothesis about a chemical imbalance in the brain being the cause of depression had been discredited.

One of the main aims in establishing the Cochrane Collaboration in 1993 was to assist patients in their decision making. However, the whole Background section is about what doctors think and the review is highly paternalistic. There is no mention that many patients want to come off the drugs, which should have been the key motivation for the authors to do their review.

There is no mention in the Background section that the tapering should be hyperbolic, which is essential if one wishes to minimise withdrawal symptoms, whereas the authors quote a NICE guideline from 2009 without criticising it for recommending a fast, non-hyperbolic tapering that is outright dangerous, as it can cause akathisia, suicide and violence. When we started Cochrane in 1993, we were willing to criticise the authorities. The current leadership wants to please the authorities and the drug industry, which this Cochrane review demonstrates.

The abstract of the Cochrane review is 915 words, four times as long as ours of 236 words. But length is not a substitute for quality. The Cochrane abstract states that “We cannot make any firm conclusions about effects and safety of the approaches studied to date” and that “Future studies should report key outcomes such as successful discontinuation rate.”

Our little abstract is far more informative. We included fewer but more relevant studies and found a median successful discontinuation rate of 50%. More importantly, we noted:

“A meta-regression showed that the length of taper was highly predictive for the risk of relapse (P = 0.00001). All the studies we reviewed confounded withdrawal symptoms with relapse; did not use hyperbolic tapering; withdrew the depression drug too fast in a linear fashion; and stopped it entirely when receptor occupancy was still high.” We concluded that “The true proportion of patients on depression drugs who can stop safely without relapse is likely considerably higher than the 50% we found.”

The lengthy Cochrane abstract did not mention any of these essential issues.

Cochrane is in deep trouble

Currently, faced with an ongoing crisis caused by multiple missteps, Cochrane’s Editor-in-Chief, Karla Soares-Weiser, has hired the pricey consulting firm Envoy to address scientists’ concerns about her lack of transparency, leadership, and communication skills.

The crisis came to a head in March, when Soares-Weiser rushed out an apology even though there was nothing to apologize for, which undermined Jefferson’s and colleagues’ Cochrane review that showed that masks did not reduce respiratory viral infection. Soares-Weiser even claimed, totally falsely, that “the review is not able to address the question of whether mask-wearing itself reduces people’s risk of contracting or spreading respiratory viruses.” This was one of the aims of the review!

When investigative journalist Paul D Thacker asked for insight into how Cochrane had handled his request for comment and answers in relation to this scandal, he received heavy redacted documents:

So much for Cochrane transparency, which appears in the first of Cochrane’s 10 key principles: “Collaboration by fostering global co-operation, teamwork, and open and transparent communication and decision-making.” What is the difference to the drug industry?

Thacker called his article: “Cochrane: world’s preeminent medical information resource goes into tailspin.” It should come as no surprise that many people who were previously very supportive of Cochrane now see it as a slowly dying organisation.

The post Cochrane Reviews of Psychiatric Drugs Are Untrustworthy appeared first on Mad In America.

Electroshock, also called electroconvulsive therapy (ECT), was highly praised in the textbooks. One book recommended ECT or pulsating electromagnetic fields (PEMF) for treatment-resistant depression,^16:275 and another book noted that ECT must always be considered for this condition.^17:364

It was claimed that ECT stimulates the formation of new neurons and the maintenance of the dendrite tree,^16:558 and the development of new neurons in hippocampus.^17:746 A third book noted that no acute or permanent brain damage had been demonstrated in the many scanning studies, and that a few studies suggest that the neurogenesis in the hippocampus increases.^18:245

The truth is that the brain reacts to harm by producing new neurons.¹¹ A harmful effect was therefore praised as being beneficial, which is common in psychiatry. There were no references.

One book claimed that it has not been possible to detect brain damage; that retrograde amnesia is difficult to interpret and difficult to distinguish from problems triggered by the disease; that some studies suggest a slight memory loss a year after ECT whereas other studies do not find it; and that long-term symptoms experienced by the patients after ECT are extremely rare and not with certainty related to it.^17:745 By using the word “experienced,” the author downgraded what the patients tell their psychiatrists about the harms of ECT.

In another book, the same author claimed that brain damage has never been diagnosed after ECT while noting that almost all patients get amnestic symptoms in a treatment series.^16-556 This is full-blown cognitive dissonance. If amnesia after ECT is not a sign of brain damage, what is it then? How can anyone argue this way? People who become amnestic after a concussion are told it is because they had a brain damage.

The author explained that the anterograde amnesia recovers two weeks later while retrograde amnesia is more uncertain. He noted that some studies suggest a slight memory loss 6-12 months later whereas prolonged experiences of inconveniences are extremely rare. This author, a professor of psychiatry, ignored the facts when asking if the problems were due to ECT or the disorder.

Other authors also denied the facts. They noted that, rarely, a few patients experience “subjective inconveniences” in the form of lacunas in retrograde memory and claimed that it is difficult to judge if they are harms of ECT because patients with severe depression also often have such lacunas.^18:244

The memory problems are not just subjective (which is the standard script: Blame the victim, not the treatments); they have been verified in numerous studies.

Elsewhere in this book, the authors wrote about a short-term memory dysfunction, and that thorough studies with imaging methods had not shown damage to the nerve tissue.^18:231

This is just incredible. ECT causes memory loss in most patients^573-575 and permanent memory loss in some patients, which means irreversible brain damage.^96,121 ECT furthermore kills some patients,⁵⁷³ which means that every single brain cell is dead.

The organised denial of the harms caused by ECT was astounding. My translation of the above is: We psychiatrists do not worry about the memory problems we cause; the patients already had memory problems before we electroshocked them; the memory problems patients tell us about are not real (only “subjective”); and we need not pay attention to what the patients tell us anyway because they are mentally ill. In my view, psychiatrists are too dangerous to have around.

The descriptions of what ECT does to people are among the most dishonest I encountered when reading the five textbooks, and this also applies to the postulated benefit. We are told that ECT is extremely effective against severe depression;^18:231 and that it can be lifesaving.^18:244 This agrees poorly with the information in the same book that, usually, 8-16 shocks are given.^18:244 ECT is also used in patients with mania to prevent delirium acutum.^18:114

It was claimed that 80% of patients with affective disorders respond to ECT,^17:360 but there was no control group and no reference.

Here is an account of the facts.^7:207 In the Cochrane review of ECT for patients with schizophrenia, which is from 2005,⁵⁷⁶ more people improved on ECT than on placebo or sham ECT, risk ratio 0.76 (0.59 to 0.98), but this finding is unreliable. It was barely statistically significant; the trials were small (only 392 patients in 10 trials); the larger the trial, the smaller the effect, which suggests that negative trials exist that haven’t been published; and the authors only excluded trials from their review if more than 50% of the patients were lost to follow-up, which is far too generous. Other researchers have concluded that all the sham ECT trials are grossly flawed.⁵⁷⁷

The Cochrane authors reported that, using the Brief Psychiatric Rating Scale, ECT was better than sham ECT, but there were only 52 patients in the analysis, and we have no idea how many patients or data that were missing or why. Further, the difference was only 6 on a scale that goes to 126, which is not a clinically relevant effect (see Chapter 7, Part One about a similar lack of a relevant effect of psychosis pills).

Even more worrying, ECT was considerably less effective than psychosis pills, e.g. twice as many patients weren’t improved in the ECT group, risk ratio 2.18 (1.31 to 3.63).

The authors didn’t draw firm conclusions about any short-term benefit, and there was no evidence for a long-term benefit.

A 2003 review found that ECT was more effective than simulated ECT for depression (6 trials, 256 patients, effect size -0.91 (-1.27 to -0.54), corresponding to a Hamilton score difference of 10, and ECT was also better than drugs (18 trials, 1,144 patients, effect size -0·80 (-1.29 to -0.29).⁵⁷⁸ This looks impressive, but these are short-term effects; the quality of the trials was poor; most trials were small; the results would likely change materially if a few neutral studies were identified; the trials rarely used outcomes relevant for clinical practice; and the data suggested that ECT caused cortical atrophy in the brain. The authors advised that the trade-off between making ECT optimally effective in terms of amelioration of depressive symptoms and limiting the cognitive impairment should be considered.

Psychiatric researchers often avoid saying in plain language what they found and what it means, as it would be threatening to the psychiatric guild. They should have said that it is uncertain if ECT for depression does more good than harm, particularly as it caused brain damage and as only short-term studies were evaluated. Systematic reviews have failed to find benefits beyond the treatment period, both for schizophrenia and for depression.^573,578

Many psychiatrists believe ECT can be life-saving, but there are no reliable data in support of this belief,^573,578 whereas we know for sure that ECT can be deadly. A systematic review found a death rate of about 1 per 1000,⁵⁷³ which is 10 times higher than what the American Psychiatric Association says. When I lectured in Brisbane in 2015, a mother told me that the psychiatrists killed her son with ECT but they resuscitated him. When he woke up, he had severe burns and the next two to three months he couldn’t say anything people could understand. He is permanently brain damaged and his social skills are very poor; he cannot live on his own.

In 2003, the UK Royal College of Psychiatrists’ fact sheet stated that more than 80% of depressed patients respond well to ECT and that memory loss is not clinically important.⁵⁷⁵ We do not ask a hairdresser if we need a haircut. The patients disagreed and the lowest satisfaction levels were obtained in studies led by patients rather than by psychiatrists.

If we want to know the truth about psychiatric drugs and electroshock, we need to listen to the patients and not to the psychiatrists.¹²¹ One Danish patient couldn’t remember even the commonest things, like the name of the Danish capital, after she was electroshocked.¹²¹ She was permanently brain damaged by electroshocks she should never have received because her problem was that she had been sexually abused as a child. She didn’t have any psychiatric disorder. Her book is a frightening account of what is wrong with psychiatry.¹²¹

Studies of ECT using routine neuropsychological tests have concluded that there is no evidence of persistent memory loss, but what is measured is typically the ability to form new memories after treatment (anterograde memory). Reports by patients of memory loss are about the erasing of autobiographical memories, or retrograde amnesia, and they are damning.⁵⁷⁵ With a strict definition of memory loss, between 29% and 55% of the patients are affected. With looser criteria, the range goes from 51% to 79%.

Other studies also show that ECT may cause permanent brain damage.⁵⁷³ In the 1940s, it was acknowledged that ECT “works” because it causes brain damage and memory deficits, and autopsy studies consistently found brain damage, including necrosis.

It is blatantly dishonest to say, as the psychiatrists who authored a Cochrane review of depressed elderly did,⁵⁷⁹ that, “Currently there is no evidence to suggest that ECT causes any kind of brain damage, although temporary cognitive impairment is frequently reported” and that “ECT seems to be a safe procedure”.

The 2010 official guidance for general practitioners in Denmark on depression was even worse. It stated that, “Many have an unfounded fear of ECT treatment, although there is no evidence that the treatment causes brain damage; in fact, there is strong evidence that new nerve cells are formed in response to treatment.”⁵⁸⁰

ECT “works” by making people confused and by destroying their memories, which are what define us as humans, but doctors describe this as positive. They also described lobotomy and the many other harmful treatments they used in the past as positive.¹

As illustrated by the case in Brisbane, what happens in practice is far from what should happen. This has been studied systematically. Repeated audits by the Royal College of Psychiatrists showed that many hospital trusts failed to adhere to the college’s standards.⁵⁷⁵ One audit found that only a third of ECT clinics met the standards.⁵⁷⁸ There are also huge variations in clinical practice and in rates of usage.^573,575,578

In Denmark, forced treatment with ECT quadrupled in just seven years in the 1990s, but forced treatment is immensely unpleasant; the patients are very scared; it often elicits colossal bitterness and anger; and it is perceived by the patients as a breach of trust.⁵⁸¹

There is a very moving documentary about Mette Askov, a Danish nurse who had heard voices since she was eight years old and was a psychiatric patient for 15 years.⁵⁸² She was diagnosed with paranoid schizophrenia and received vast amounts of medicine, 150 electroshocks and a disability living allowance. She was stigmatised and surrounded by prejudice but after she reclaimed her own life and left psychiatry, she achieved some of her greatest goals. Her story illustrates so well what the psychiatrists’ abuse of forced treatments lead to. Even when they so clearly don’t work, the psychiatrists continue to use them.

I have heard many stories where psychiatrists describe miraculous improvements and grateful patients. I was once asked at a meeting after my lecture about drugs what my view was about a woman who was so depressed that she could hardly be contacted but asked for a glass of water after an electroshock.^8:87 I said that since this was an anecdote, I would reply with another anecdote. I examined a newly admitted man, an unconscious alcoholic, and as I needed to rule out meningitis, I tried to insert a needle in his back to tap cerebrospinal fluid for microscopy and culture. It was very difficult to get in and I hit his bone several times. All of a sudden, the drunkard exclaimed loudly: “Bloody hell, stop stinging me in the back!” Had I caused a miracle with my needle and cured the guy? No. Odd things happen all the time in healthcare. Could I have woken up the deeply depressed woman with my needle? Who knows, but maybe?

Some psychiatrists I have met have never used electroshock. This barbaric treatment should be made illegal, just as lobotomies were. In particular, no one should be forced to get electroshocks against their will.

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook Chapter 12: Electroshock appeared first on Mad In America.

As noted earlier, an editor of one of the textbooks,¹⁸ Poul Videbech, wrote in 2014 that depression doubles the risk of dementia,⁴⁰⁸ but the meta-analysis he cited did not mention with one word which treatments the patients had received.⁴⁰⁷ Other studies suggest that it is depression pills and other psychiatric drugs that make people demented.^557,558

The information about treatment of dementia was highly misleading. In one book, the chapter about Alzheimer’s disease was written by two psychologists^20:341 who went into detail about the drugs, even though this is none of their business, as psychologists are not allowed to prescribe drugs in Denmark. They claimed that acetylcholinesterase inhibitors can dampen the development of symptoms^20:351 but none of their 19 references were to research documenting this.

Two other psychologists wrote that the drugs have a better effect on Lewy body dementia and dementia in Parkinson’s disease than in Alzheimer’s disease on cognitive functions, apathy, visual hallucinations, delusions, and other neuropsychiatric symptoms.^20:375 These finger-tip sensations are far-fetched for drugs that don’t work (see below), and none of their 38 references were about drug effects whereas several were about psychotherapy and other therapies, e.g. a meta-analysis of the effect of dancing in patients with Parkinson’s disease. Very strange, indeed.

Another book claimed that drugs can inhibit the progression of Alzheimer ‘s disease for months to a few years, and that donepezil, galantamine, and rivastigmine have equal effect.^18:48

A third book mentioned that acetylcholinesterase inhibitors may delay the decline in functional level and behaviour.^17:243 This became more concrete 424 pages later: Drugs, primarily acetyl-cholinesterase inhibitors, may to some extent re-establish lost cognitive skills as well as postpone further deterioration. The progression in Alzheimer’s can be delayed for 6-12 months.^17:667

A fourth book did not pull any punches either.^16:127 It claimed that, in a minority, a clear improvement of cognitive functions is experienced, with resumption of earlier activities and possible disappearance of hallucinations or other neuropsychiatric symptoms. The authors also claimed that acetylcholinesterase inhibitors may have a beneficial effect on behavioural and psychological symptoms of dementia and may delay their onset.

Dementia was of course not an issue in the textbook about child and adolescent psychiatry.¹⁹

All these statements are totally wrong. There wasn’t a single reference to placebo-controlled trials or meta-analyses, which would have told a story of drugs that don’t work and are harmful.^7:197

The small subjective effects registered in drug trials are likely spurious, as they can easily have been caused by unblinding bias because of the drugs’ conspicuous adverse effects.

A 2006 Cochrane review of donepezil, galantamine, and rivastigmine didn’t pay attention to this problem and concluded that, “The three cholinesterase inhibitors are efficacious for mild to moderate Alzheimer’s disease.”⁵⁵⁹ Even without considering the unblinding problem, this conclusion was unwarranted. The improvement in cognitive function was 2.7 points, in the midrange of a 70-point scale. This is less than the 4 points the FDA considers the minimally relevant clinical change.⁵⁶⁰ We may also compare with the smallest effect that can be perceived on the Hamilton scale for depression, which is 5-6, although the maximum is only 52.²⁶⁷

The author of the Cochrane review wrote that “donepezil appears to have no serious or common side effects.” This is so egregiously false that I don’t think Pfizer would have dared claim this in one of their advertisements for Aricept (donepezil).

The harms are both common and serious, which the author of the Cochrane review actually demonstrated herself, as 29% of the patients dropped out of the drug groups, as compared to only 18% in the placebo groups, partly because of more adverse events.⁵⁵⁹ The most common harms of donepezil are nausea, diarrhoea, insomnia, vomiting, muscle cramps, fatigue, and anorexia.⁵⁶¹ This is not what we would want for an old person who might already have problems with bad sleep, feeling tired, and eating too little.

The list of frequent adverse effects in Pfizer’s product information for Aricept is very long.⁵⁶¹ The drug causes syncope in 1% of the patients and when old people fall, there is a considerable risk that they break their hip and die. A large Canadian cohort study showed that if people with dementia took dementia drugs, they had almost a doubled risk of hospitalisation for syncope, and they had more pacemakers inserted and more hip fractures.⁵⁶² More than half of the patients who were admitted to hospital for bradycardia were retreated with the same type of drug after discharge.⁵⁶² This is yet another proof that doctors cannot handle psychotropic drugs safely.

A 2014 study, of 5,406 nursing home residents in the United States with advanced dementia, found that one-third received cholinesterase inhibitors and one-fourth memantine, another dementia drug.⁵⁶³ The title of the paper was appropriate: “Use of Medications of Questionable Benefit in Advanced Dementia.”

It is interesting that no benefits for society have been found,⁵⁶⁴ as we so often hear about the economic burden of dementia and how important it is to intervene with drugs.

The political sales pitches—which tend to coincide with general elections—are vacuous. A long-term trial of 565 patients with mild to moderate Alzheimer’s disease that compared donepezil with placebo found no meaningful effects, and the authors concluded that donepezil isn’t cost-effective, with benefits below minimally relevant thresholds.⁵⁶⁵

In contrast to other trials, this trial was publicly funded. It was excluded from the Cochrane review,⁵⁵⁹ and the author used 511 words on explaining why. The main reasons appeared in a table: “Results for the 5 and 10 mg/day groups were not reported separately. Complex design and high numbers of dropouts made analysis and interpretation difficult.”

It is not acceptable to exclude a study because it combines two dose groups in the results. And that the design was complex is not a valid reason either for its exclusion. Furthermore, as it was a long-term trial, where more people drop out than in short-term trials, the high drop-out rate was also an invalid reason for exclusion.

The outcome after three years was similar on drug and placebo for institutionalisation, progression of disability, and behavioural and psychological symptoms.⁵⁶⁵

Extremely few trials in psychiatry run for three years but such trials are exactly those we need instead of the thousands of short-term trials we have, which are useless for an assessment of drug effects, as very few patients are treated for only a few weeks.

Six years after the trial was published, TV commercials for Aricept implied that the patients’ cognitive and daily functioning, including attention, focus, orientation, communication, social interaction and engagement, will be restored to normal; “Don’t wait. Talk to your doctor about Aricept.”⁵⁶⁶ The FDA told the company that—with these huge lies—it had broken the law.

You should not talk to your doctor about dementia drugs because, as the textbooks so clearly showed, your doctor is highly likely to mislead and harm you. These drugs should not be used by anyone to prevent or treat dementia.

Three critical comments have been published on the 2006 Cochrane review, including mine.⁵⁵⁹ Unfortunately, contrary to good scientific practice, they are undated. The author apologised for an error, which she said would be corrected in the next version, and she replied to me that another error had “also now been corrected.” It has not been corrected. In 2015, I was told that “An update of the review … is in preparation.”⁵⁵⁹ The review has not been updated. It stands as a gravestone over a once magnificent organisation, which is currently facing big financial trouble because it has not lived up to the expectations of its major funder, the UK National Health Service.¹⁴⁶

There are other Cochrane reviews of these drugs, e.g. one in vascular dementia, which is not encouraging either.⁵⁶⁷ The authors concluded that donepezil and galantamine have a small effect on cognition but that it is unlikely to be clinically important.

One of the textbooks noted that psychosis pills cause considerable harms, e.g. an increased risk of thrombosis in the heart and brain and an increased risk of death.^16:127 It claimed that risperidone and olanzapine have a documented minor effect in dementia.^16:127 This was in a chapter about dementia written by two doctors who work with these patients. In another chapter, about psychopharmacology, the author contradicted this, as she noted that psychosis pills should be avoided in elderly people with dementia and behavioural disorders due to the lack of evidence for an effect, increased sensitivity to harms, and an increased risk of stroke.^16:561 She did not mention the most important reason to avoid these drugs: To avoid killing patients in large numbers (see Chapter 7).

This demonstrated a general issue. People who treat patients become carried away by their “clinical experience” and other biases and are much too positive towards the effects of psychiatric drugs. They are therefore not the most trustworthy textbook authors. They have many vested interests, too, very often financial ones related to the drug industry.

Even people who should know better can be disappointing. A clinical pharmacologist acknowledged at a public meeting that the drugs don’t work but he recommended that they should be tried, as they work better in some people than in others. I asked him if he had never heard about statistical variation. With his argument, we could use whatever we pleased that doesn’t work.

The perspective is chilling. Doctors are like children. They cannot keep their fingers away from dangerous toys, which is why we should take all the ineffective and dangerous psychiatric drugs off the market. I suggested this in a newspaper article in 2014.¹⁸⁹

As I doubted it could be true that risperidone and olanzapine work for dementia,^16:127 which no drugs do, I browsed the Internet and found a trial of olanzapine.⁵⁶⁸ I had been duped again. It was not about having an effect on dementia but about calming down disturbing Alzheimer patients with a major tranquilliser, and the patients became somnolent and developed gait disturbances. I also found a Cochrane review, but this was also not about treating dementia but about treating aggression and psychosis in people with dementia. Everything I found was about this.

This book noted that the effect of depression pills is very limited and added that a minority without depression develop depression after discontinuation.^16:131 This is interesting because it is an iatrogenic harm, an abstinence depression (see Chapter 8, Part Twelve).

Yet again, this was not about treating dementia, it was about treating depression in people with dementia. I found a Cochrane review, which was also discouraging.⁵⁶⁹ It noted that the data were of variable quality and unsupportive: “On the only measure of efficacy for which we had high‐quality evidence (depression rating scale scores), antidepressants showed little or no effect.”

As noted earlier, it is likely that all psychotropic drugs can cause chronic brain damage,^5,135 which may be permanent. A hallmark of this is impaired cognitive function. Chronic brain damage is related to the length of drug exposure and often worsens when the dose is increased, whereas it will usually improve considerably when drugs are tapered off. If it had been the disease that caused the problems, the patients should have become worse when the drugging was reduced.¹³⁵ A 17-year follow up of the Framingham Heart Study found that use of depression pills increased the risk of developing dementia by about 50%,⁵⁷⁰ and benzodiazepines seem to double the risk of dementia.⁵⁷¹

We should avoid drugging demented people. We should care for them. A systematic review of 33 trials of agitated demented people showed pretty large effects of care, e.g. communication skills training, activities, music, touch, massage and talking to people.⁵⁷²

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 11: Dementia appeared first on Mad In America.

Although the textbooks advised psychotherapy for anxiety disorders, their focus was on drugs.

One book noted that cognitive behavioural therapy is the best documented intervention for anxiety disorders in children, possibly supplemented with an SSRI, and it recommended this also for obsessive-compulsive disorder (OCD).^{19:143,19:167} Drugs were only indicated if there was a lack of effect of psychosocial support and cognitive behavioural therapy and where the anxiety was severely invalidating.^19:157

This is the standard script for psychiatry. Even when drugs are generally not recommended, they must always be used if the condition is severe enough.

Another book noted that psychotherapy is the preferred treatment of agoraphobia,^18:136 while a third book was more positive towards drugs. It noted that agoraphobia can be treated with cognitive behavioural therapy, depression pills, or both in combination.^16:349 For social phobia and generalised anxiety,^{16:351,16:357} cognitive behavioural therapy was considered first choice, but it was mentioned that SSRIs also have well documented effects.

There is no doubt that shyness—now called social phobia, as it is better for industry’s marketing^7:214—should be treated with psychotherapy. A 24-week trial that randomised 375 patients with social phobia to sertraline or to gradual exposure to the feared symptoms found a similar effect of exposure and sertraline, but during an additional six-month follow-up, the exposure group continued to improve, which the sertraline group did not.⁵⁴⁵ This was expected. People on drugs don’t learn anything about how to cope with their anxiety. It is like alleviating the tension with alcohol. In contrast to drugs, psychotherapy usually has enduring effects on psychiatric disorders.^180,497-501

A Cochrane review of 41 trials in children and adolescents with anxiety showed very large effects from cognitive behavioural therapy.⁵⁴⁶ The outcome was assessed blindly in 32 of the 41 trials. The odds ratio for remission, compared with waiting-list controls, was 7.85 (5.31 to 11.60), and the reduction in anxiety symptoms had an effect size of -0.98 (-1.21 to -0.74). Other psychological therapies were similarly effective.

A Cochrane review of anxiety and depressive disorders did not find a difference between the results obtained by paraprofessionals and professionals (psychiatrists or psychotherapists), effect size 0.09 (-0.23 to 0.40).⁵⁴⁷ These results agree with those from numerous other studies.^14,547 Patients can also help themselves. A Cochrane review of self-help where printed materials, audio or video recordings, computers, or the internet were used to teach adult patients behavioural or cognitive behavioural therapy for anxiety found a clear effect compared with no intervention, effect size 0.67 (0.55 to 0.80).⁵⁴⁸

For OCD, a book recommended psychoeducation, self-help material, and cognitive behavioural therapy, and SSRIs in severe cases.^16:360 The evidence for psychotherapy is strong. A Cochrane review of trials in adults found that psychotherapy resulted in far fewer symptoms than if the patients had received treatment as usual, effect size -1.24 (-1.61 to -0.87).⁵⁴⁹ The effect of SSRIs was substantially smaller, effect size -0.46 (-0.55 to -0.37) (calculated by me).⁵⁵⁰ There were few direct comparisons, but a review found that psychotherapy was better than depression pills, effect size -0.36 (-0.72 to 0.00) (calculated by me, three trials with 118 patients).⁵⁵¹

The book that recommended SSRIs in severe cases also stated that psychosis pills could possibly be used as augmentation.^16:360 There were no references to original research, ^16:369 only to a national guideline from 2007,⁵⁵² which was very brief: “There are no studies of monotherapy with antipsychotics that have shown an effect on OCD. Various open and a few double-blind placebo-controlled studies of the effect of combination therapy with a serotonergic antidepressant and an antipsychotic (p. 162) have been carried out. On this background, it is concluded that there is some evidence that risperidone and quetiapine may have an effect in augmentation treatment of OCD.”

The guideline referred to page 162 in a NICE report, which was not illuminating.⁵⁵³ It describes a few small trials and there was no systematic review of these trials.

It is difficult to understand the thinking behind the weak conclusion that risperidone and quetiapine “may” have an effect based on “some evidence.” Severe OCD can ruin the lives not only for the patients but also for their relatives, but it is not a deadly disease. In contrast, psychosis pills are some of the deadliest drugs ever invented (see page 46), apart from cancer chemotherapy, and they should be avoided, also for patients with OCD.

As SSRIs double the risk of suicide and have many other important harms, these pills should also be avoided. The book noted that SSRIs and SNRIs may increase anxiety, and that it takes longer than for depression before they work, but that there is continued improvement after several months.^16:368 To say that it takes longer than for depression before they work means they don’t work, but the psychiatric mindset doesn’t allow such admissions.

On the same page, this book offered horrible advice also about benzodiazepines.^16:368 It mentioned that a study had found an effect after years of treatment, especially with alprazolam and clonazepam, but that generally only a few weeks of treatment is recommended while treatment with a depression pill is started. Alprazolam is a very harmful drug. After a few weeks, many people have become dependent on it, and the rebound effect when it is stopped is so pronounced that the patients become worse than they were when they started therapy.^5:295

This book also claimed that pregabalin, an antiepileptic, works and is approved for anxiety disorders. It is bad medicine to use antiepileptics for anxiety given their many serious harms, including a doubling of the suicide risk.^390,439

The literature list did not provide support to the harmful recommendations launched by a psychiatrist as sole author.

Further ahead, another author wrote more soberly about benzodiazepines, contradicting the first author:^16:585 The information on the anxiolytic effect is conflicting and there is a lack of long-term studies. Furthermore, there is development of tolerance (the effect vanishes over time), and cessation causes physical abstinence symptoms, including anxiety, restlessness, irritability, difficulty sleeping, tremor, photo- and phonophobia, flu-like symptoms and rebound phenomena.

Even though the abstinence symptoms are very much the same for SSRIs and SNRIs as for benzodiazepines (see Chapter 8, Part Three),⁵⁵⁴they were not called abstinence symptoms in any of the textbooks.

The psychiatrist author wrote that when stopping, 10-20% of the starting dose should be removed every other week, but in the last part of withdrawal it may be necessary to reduce with even smaller doses and extend the intervals.^16:586 Another book had similar advice, a dose reduction of 10-20% with 1-2 weeks intervals and possibly even slower in the final phase.^18:71

It is of utmost importance that the dose reductions are much smaller by the end of a taper-ing.²⁸¹ But none of the books explained that the binding curves for psychiatric drugs are hyperbolic (as I will explain in Chapter 15), and that the tapering therefore needs to be exponential. This is unfortunate, as very few doctors know about correct withdrawal and cause terrible harms by withdrawing the drugs much too quickly.

A third book recommended either cognitive behavioural therapy or SSRIs for social phobia, for 6-12 months, if there is effect.^18:136 It noted that benzodiazepines should not be used long-term due to dependence, and because abstinence symptoms can be difficult to distinguish from the primary anxiety symptoms. It is true that rebound anxiety is a very common abstinence symptom. But why was the same not said about SSRIs and SNRIs in any of the textbooks? The same problems occur,⁵⁵⁴ but the authorities also failed badly, as they ignored the dependence problems with depression pills for two decades.³⁰⁴

In the same book, other authors contradicted this, as they said that benzodiazepines are used long term for anxiety such as panic attacks when cognitive behavioural therapy or depression pills have not had sufficient effect.^18:240 This is horrible advice.

The two remaining books escalated the confusion. Two psychologists claimed that SSRIs and cognitive behavioural therapy should often be combined to get the best result in OCD and that most studies had shown remission in 60% of the patients,^20:485 a meaningless statement, as there is no control group. There were 47 references but none of them were about the effect of SSRIs.

The fifth book contradicted this, noting that, according to the National Board of Health,⁵⁵⁵ the effect is not increased by adding depression pills to psychotherapy,^17:420 which, also considering the harms, was the reason the Board does not recommend pills.

The authors noted that, on SSRIs, 60-70% will experience a 50% reduction in panic symptoms and 50-60% will have an effect on social phobia, but they added that 60% will experience an effect of placebo on panic attacks.^17:404 What is the reader supposed to conclude based on this?

The authors also claimed that, according to a meta-analysis, about half of the patients with OCD will come in remission but none of their 13 references were to a meta-analysis.^17:420 There was a reference to an article about escitalopram, but it was irrelevant and there was no mention of it in the text.⁵⁵⁶

From then on, it became worse in this book.^17:423 The authors spoke about extensive evidence for the effect of SSRIs and that we should try another one or increase the dose beyond the maximum (in rare cases) if the effect is insufficient. We could also add a small dose of a psychosis pill, which is effective according to clinical experience. But they added that the National Board of Health says that no clinically relevant effect has been shown and that there is risk of harms and that, in some cases, psychosis pills can cause or worsen OCD.

This is confusing and contradictory, and the authors felt that clinical experience is more important that advice from the Board of Heath. Furthermore, it seems that the 2007 national guideline for anxiety disorders⁵⁵² is in conflict with the one specifically for OCD.⁵⁵⁵ The guideline for OCD was updated in 2019. During these 12 years, the apparent effect of psychosis pills in 2007 disappeared:

“As there is insufficient evidence from the paediatric literature on augmentation therapy with antipsychotics, the question is solely addressed in adults … Use only after careful consideration an atypical antipsychotic as augmentation therapy for adults with severe OCD who have had no effect of treatment with cognitive behavioural therapy and antidepressants (SSRIs), as no clinically relevant effect has been demonstrated and as there is a risk of side effects.”

This textbook opined that the primary drug treatment for anxiety is depression pills.^17:664 Benzodiazepines should not be used for more than four weeks but can be used for longer, e.g. if the patient has panic attacks. We are even told that pregabalin can be used because the harms are relatively mild. Antiepileptics have many harms, one of which is to double the risk of suicide.^390,439

This horrible and harmful advice suggests that patients with anxiety disorders should avoid seeing a psychiatrist. It is too dangerous.

***

To see the list of all references cited, click here.

The post Critical Psychiatry Textbook, Chapter 10: Anxiety Disorders appeared first on Mad In America.