“If it can be solved by $5,000 or a new boyfriend, it’s not depression.”
– Ned Shorter, Hannah Professor in the History of Medicine and Professor of Psychiatry at the University of Toronto
- Antidepressants explained
- How do SSRIS and other antidepressants work?
- Most common antidepressants
- Side effects
- Withdrawal – the worst “side effect”
- Common adverse effects of antidepressants
- Other side effects
- Trends and data
- Drug regulation and antidepressants
- Myths and misinformation
- Myth 1: Your disease is caused by a chemical imbalance in the brain
- Myth 2: It’s no problem to stop treatment with antidepressants
- Myth 3: Psychotropic drugs for mental illness are like insulin for diabetes
- Myth 4: Psychotropic drugs reduce the number of chronically ill patients
- Myth 5: Happy pills do not cause suicide in children and adolescents
- Myth 6: Happy pills have no side effects
- Myth 7: Happy pills are not addictive
- Myth 8: The prevalence of depression has increased a lot
- Myth 9: The main problem is not overtreatment, but undertreatment
- Myth 10: Antipsychotics prevent brain damage
- How should we use psychotropic drugs?
Selective serotonin-reuptake inhibitors, or SSRIs, and serotonin and noradrenaline-reuptake inhibitors, or SNRIs, are the most commonly prescribed antidepressants. Dr. David Healy notes that the terms SSRI and SNRI are marketing terms, and not scientific or clinical. These drugs are not useful for treating serious depression, and they definitely do not solve the problems of everyday living that cause people to be sad and worried. In the fifth edition of his book Psychiatric Drugs Explained, he starts his chapter on antidepressants as follows:
“It is more difficult to specify exactly what antidepressants do than it is to say just what other drugs that act on the brain do. Part of the problem lies in trying to agree what depression is… Part of the problem lies in our changing views of depression brought about by the interaction between the development of antidepressants and the marketing strategies of drug companies. When first developed, these drugs were used to treat a condition called melancholia or endogenous depression but the boundaries between this disorder and sadness have been obliterated and many people now get antidepressants who perhaps shouldn’t.”
 Pyschiatric Drugs Explained, Fifth Edition, Churchill Livingston, 2009, p 51
Dr. Healy goes on to explain that antidepressants are little use for people who have psychological symptoms in the absence of physical symptoms such as: loss of energy, loss of interest, poor concentration, altered sleep patterns, altered appetite, plus other physical symptoms. He notes that antidepressants “are not anti-psychological problem pills”.
In other words, too many people are taking these drugs for different underlying conditions, some of which they are not useful for treating. Expectations of consumers and physicians increase the demand for the drugs, and perceptions of their benefit are shaped by other factors than true efficacy. For example, minor “depression” often goes away in a matter of months, and if a person is taking an antidepressant, they may feel better for reasons that have nothing to do with the medication. Similarly, other factors in treatment may cause an improvement in mood and outlook, while a person is taking an antidepressant. In these cases they may believe that the drug caused them to feel better when in reality a sugar pill would have worked just as well.
How do SSRIS and other antidepressants work?
Whole books, for example The Emperor’s New Drugs by Irving Kirsch, have been written about the lack of effectiveness of these medications. However, these medications definitely do something. Reading thousands of stories about these drugs, it becomes clear that they have effects, which may not be what non-users imagine. People who take them report feeling different, and clinicians like Healy insist that they can sometimes be very useful, especially if taken for short duration. “This is because of their anxiolytic properties, which can be energizing, or may simply blunt the experience of of difficult emotions,” says Healy. “These are not “happy pills”. Whatever happiness is, it does not come from behind the counter of your local pharmacy.”
Many people who take these drugs report feeling “detached”. They lose their ability to empathize, their inhibitions and their judgement. Sometimes, they lose their natural fear of death. In short, their emotions are blunted. They do not make people happy. SSRI antidepressant pills free them from the restrictions imposed by feelings for others, of conscience, and self-control. Peoples’ natural instincts that would normally make them feel horror at the idea of driving into oncoming traffic, jumping off a cliff, stabbing someone, stealing, hitting or shooting can be diminished by these medications. While it might be a good thing to reduce exam-related panic, when this same effect overrides reluctance to die because of unpleasant life events, it is not so positive.
“Antidepressants have so many dangerous and unpleasant side effects that doctors should be very careful in prescribing them”, according to Dr. Derelie Mangin, the current David Braley and Nancy Gordon Chair in Family Medicine at McMaster University . “Patients need to be better informed so that they do not develop unrealistic expectations about what pills can do to help them. Many people who take antidepressants would be much better served by a program of routine, vigorous exercise.”
Most common antidepressants
There are two main categories of antidepressant: the SSRIs and SNRIs, of which Prozac (fluoxetine) was the first, approved for use in the USA in 1987, and the older Tricyclic drugs, (e.g. imipramine). Common antidepressants are listed below with their chemical name first and their brand names second. Brand names are often country specific.
The links on the chemical names take the reader to RxISK.org where reported side effects, patient naratives, and other information is provided. You might also want to check out a particular antidepressant in the sex, suicide, and violence zones on RxISK.org, where the reported side effects for each are described.
|SSRI and SNRI Antidepressants|
|Bupropion||Wellbutrin, Budeprion, Prexaton, Elontril, Aplenzin|
|Citalopram||Celexa, Akarin, Celapram, Celius, Ciazil, Cipramil, Cipram, Cimal, Citabax, Ciprapine, Citalec, Citol, Dalsan, Cilift, Recital, Emocal, Sepram, Seropram, Citox, Cital|
|Duloxetine||Cymbalta, Ariclaim, Xeristar, Yentreve, Duzela, Dulane|
|Escitalopram||Lexapro, Cipralex, Seroplex, Esertia|
|Fluvoxamine||Luvox, Fevarin, Faverin, Dumyrox, Favoxil, Movox, Floxyfral|
|Paroxetine||Paxil, Seroxat, Sereupin, Aropax, Deroxat, Divarius, Rexetin, Xetanor, Paroxat, Loxamine, Deparoc|
|Sertraline||Zoloft, Lustral, Serlain, Asentra, Tresleen|
|Trazodone||Desyrel, Oleptro, Beneficat, Deprax, Desirel or Desyrel, Molipaxin, Thombran, Trazorel, Trialodine, Trittico, Mesyrel|
|Tricyclics||Amitriptyline, Anafranil (clomipramine), (Amoxapine, Desipramine (Norpramin), Dosulepin, Doxepin, Imipramine (Tofranil) Nortriptyline (Pamelor), Protriptyline (Vivactil), Trimipramine (Surmontil)|
|Other Antidepressant/ Anxiety/ Tranquilizer medications|
|Benzodiazepines||Ativan (lorazepam) aka Lorenin, Lorsilan, Temesta, Tavor, Lorabenz; Atarax (hydroxyzine, hydroxyzine hydrochloride) aka Vistaril; Dalmane (flurazepam) aka Dalmadorm; Dormex (brotizolam) aka Lendormin, Noctilan, Sintonal; Halcion (triazolam); Klonapin (clonezepam) aka Rivotril, Iktorivil, Paxam; Lectopam (bromazepam) aka Bromam, Lexotanil, Lexotan, Librium (chlordiazepoxide) aka Elenium, Libritabs, Nobrium (medazepam); Risolid; ProSom (estazolam); Restoril (temazepam); Tranxene (clorazepate) aka Tranxilium; Valium (diazepam) aka Antenex, Apaurin, Apzepam, Apozepam, Hexalid, Pax, Stesolid, Stedon, Vival, Valaxona; Versed (midazolam); Xanax (alprazolam) aka Helex, Xanor, Onax, Alprox, Restyl, Tafil, Paxal, Serax (oxazepam)|
|Neuroleptics||Abilify (aripiprazole), Chlorpromazine (Thorazine), Depixol aka Fluanxol (flupentixol or flupenthixol), Fanapt aka Fanapta aka Zomaril (iloperidone), Modecate (fluphenazine), Geodon (ziprasidone), Haloperidol (Haldol), Invega (paliperidone), Latuda (lurasidone), Fentazin, Trialvil (perphenazine), Risperdal (risperidone), Seroquel (quetiapine), Zyprexa (olanzapine)|
|Other||BuSpar (buspirone), Equanil aka Meprin aka Miltown (meprobamate), Zopiclone (cyclopyrrolone) aka Imovane Zimovane|
Negative side effects, also known as “adverse drug events” or simply “adverse events”, are most likely to occur when:
- starting a drug;
- the drug dosage is increased or lowered:
- switching from one drug to another;
- a new drug or drugs is/are added to current prescriptions; or
- a drug is discontinued.
Psychological adverse reactions are frequently misdiagnosed as spontaneous psychiatric symptoms, even though warning labels now make reference to certain psychiatric events. For example, long-term use of SSRI antidepressants often leads to mood changes that get labelled “bipolar disorder”. Despite the clear evidence provided in books like Anatomy of an Epidemic by Robert Whitaker, it is not yet well recognized by doctors or patients that this problem and others are iatrogenic (treatment-induced).
Unfortunately, many psychiatrists mistake adverse reactions for inherent disorders which have been “unmasked”. The premise of unmasking is that whatever symptom has appeared after starting or stopping the drug would have happened anyway and the drug merely uncovered a pre-existing problem. Believing in the concept of “unmasking” is one way that doctors rationalize the fact that patients are harmed by the drugs. Physicians who are not too alert and not too ethical convince themselves that the damage that happens when drugs are given has nothing to do with the drugs. Responsible physicians understand that when people take drugs and their physical and emotional wellbeing deteriorates, the first suspect to be ruled out should always be their prescription medication(s).
The stories on this site include many where young people have been casually given prescriptions for antidepressants, for situational conditions such as loss of a loved one, bullying by classmates, or anxiety about school or relationships. Too often, the treatment intended to cushion the impact of unhappy life experiences results in suicide, homicide, alcoholism, or drug addiction. It is axiomatic that had the families known of the risks, they would tried to have prevented their loved one from taking the drug. But families do not know, because they are not told. If they ever realize that the antidepressant was the problem, it happens only after serious damage has been done, which in too many cases is death.
Withdrawal – the worst “side effect”
Withdrawal, especially abrupt withdrawal, from any antidepressant medications can cause severe psychiatric and/or physical problems. Every individual is slightly different, but it is important to withdraw slowly from these drugs, sometimes over a period of a year or more, and ideally under the supervision of a qualified and experienced specialist. In many jurisdictions, doctors who have the knowledge and the will to assist their patients to withdraw, are hard to find. Withdrawal is often more severe than the original symptoms or problems for which the antidepressant prescription was given.
Withdrawal can cause a wide range of symptoms, from headaches, brain “zaps”, insomnia, lethargy or fatigue, to feeling anger, irritation or even extreme, uncontrollable rage, and countless others.
The following RxISK.org research papers deal with dependence and withdrawal:
- Dependence and Withdrawal
- Halting Antidepressants
- Medicine Induced Stress Syndromes
Click here to view these and other RxISK.org research papers.
Common adverse effects of antidepressants
Common side effects of antidepressant use include: nausea, dry mouth, headaches, diarrhea, nervousness, agitation or restlessness, bruxism (teeth grinding), reduced sexual desire, difficulty reaching orgasm, impulsivity, akathisia (unbearable internal restlessness or agitation), irritability, hostility, fetal abnormalities (when taken by pregnant mothers), loss of empathy, loss of motivation, loss of libido and impaired sexual response (erectile dysfunction in men, and loss of orgasm in both sexes), rash, increased sweating, weight gain, drowsiness and insomnia.
Sleep disturbance, including insomnia and parasomnias are listed in most literature, but the degree to which these effects are debilitating is easy to miss for those who have not experienced it. SSRIs can disrupt sleep for those taking the drug, and in withdrawal. Sleep disruption can last for months after the meds have been discontinued, even for people who ean off them gradually.
Certain effects, such as hair thinning and loss of bone density, occur when the medications are taken long-term.
Many of the minor common side effects of antidepressants are clearly highlighted in manufacturers’ literature. Some, such as weight gain, are often presented as “weight gain or loss”, a description that leaves the misleading impression that both effects are equally likely.
Sexual dysfunction affects most people who take SSRI antidepressants. A few people experience a manic reaction to these drugs and experience hyper-sexuality instead. Manufacturer information is sometimes buried, or misleading. For example, for Paxil a table is presented with footnotes where effects experienced by subjects in a 6-week trial are compared to placebo. It shows that 2% of subjects suffer this effect while no subjects in the placebo group did. Of course, healthy young subjects might not admit to loss of interest in sex, and perhaps they did not notice within 6 weeks. For most people who take SSRIs for a significant length of time, sexual side effects are guaranteed. If people realized this, they might not be so quick to demand a prescription.
Some side effects, such as craving for alcohol, are simply not acknowledged. Many people who take SSRIs become alcohol abusers. Among SSRI stories are thousands in which the combined effects of an antidepressant and alcohol bring out in people the worst effects of both. People do things while under the combined influence that they would never normally do. When Dr Healy blogged about Anne-Marie, a woman of unusual insight who eventually figured out that her SSRI was the cause of her alcoholism, RxISK.org received a flood of comments from people who suddenly recognized that their alcohol problem started soon after their SSRI prescription. (See http://davidhealy.org/out-of-my-mind-driven-to-drink/ and comments)
Other side effects
Side effects which are less common, but not rare, include: an increase in violent thoughts and impulses, suicidal ideation, mania, loss of judgment, strange or terrifying dreams, reduced inhibition, craving for alcohol, a tendency to indulge in reckless behavior, thought disturbance or full-blown psychosis, and increased propensity to drug and alcohol addiction.
Psychotropic drugs, including SSRIs, when taken for a long time, predispose people to other addictions. This is particularly true with children who are started on these drugs at a young age and become bipolar in adolescence as a consequence. Although pharmaceutical companies have denied it for years, SSRIs and other psychotropic drugs create dependency. When people get hooked on street drugs, we call it addiction and disapprove. When people get hooked on drugs prescribed by their doctors, and suffer terrible symptoms when they try to stop taking them, it is interpreted as evidence that they have a chronic illness. Their withdrawal symptoms are mischaracterized as “relapse” and proof that they need the drug to stay well.
Most alarming of all, antidepressants can cause depression and suicidality. Despite having been forced to issue black box warnings in the USA, several manufacturers fudge this one. For example, the Celexa, June, 2012 monograph cautions that:
“Depression is associated with an increased risk of suicidal thoughts, self-harm and suicide (suicide-related events). This risk persists until significant remission occurs. As improvement may not occur during the first few weeks or more of treatment, patients should be closely monitored until such improvement occurs. It is general clinical experience that the risk of suicide may increase in the early stages of recovery.”
In other words, Lundbeck is implying that Celexa makes people feel better, but until this positive effect kicks in, their depression may cause suicidality. According to their spin, it is not the drug but depression that is the problem. However, there is unequivocal evidence  that SSRI drugs can cause people who were never depressed and never had a suicidal thought, to become suicidal after taking these medications. People need to understand this, especially parents whose teenagers are among the many thousands whose GPs are offering them SSRIs to help them deal with boyfriend or exam problems.
Similarly, SSRIs cause people to become violent. Studies show that the SSRI & SNRI antidepressants are among the worst drugs for causing violence (see Trends and Data).
Long-term use of antidepressants causes permanent changes to people’s mood and reactions. Suicide and violence are the most alarming side effects, however small the percent of affected persons may be. However, depression and bi-polar, which are more common, are the most offensive side effects. People take these drugs in the belief and hope that the medication will make them feel better, only to have their long term mental health undermined by this decision. It seems that, despite books like Anatomy of an Epidemic few physicians are aware of this. Robert Whitaker pointed this out in his 2010 book, and more recently Danish internist Peter Gotzsche bluntly stated:
“Bipolar illness rose 35-fold in 20 years in the United States. It’s not only the loose criteria (for diagnosis) that cause this disaster; both SSRIs and ADHD drugs cause bipolar illness…WHO studies have shown that patients fare much better in areas of the world where psychotropic drugs are little used…People may get terrible symptoms when they try to stop (taking the drugs), both symptoms that resemble the disease and may others that they have never experienced before.”
 Emergence of antidepressant induced suicidality, David Healy, Primary Care Psychiatry, 2000 6:23–28 © LibraPharm Limited
 Deadly Medicines and Organized Crime, Psychiatry, the Drug Industry’s Paradise, Dr Peter Gotzsche, Radclofee Publishing, 2013, P196, P199
Trends and data
In 2011, the American National Department of Health and Human Services found that eleven percent of Americans aged 12 years and over were taking antidepressant medication. They found that more than 60% of Americans taking antidepressant medication had been taking it for 2 years or longer, with 14% having taken the medication for 10 years or more. The most astounding finding was that between the time periods 1988–1994 and 2005–2008 – that is, within less than 10 years – the rate of antidepressant use in the United States among all age groups increased nearly 400%.
In the E.U., antidepressant use has also experienced huge growth since the turn of the century.
In 1955, in the USA, approximately one in 13,000 people was diagnosed with bipolar disorder, and those who were diagnosed had a 50% chance of recovering without relapse. In 1985, researchers found that in Switzerland, the incidence of bipolar disorder had significantly increased since the introduction of antidepressants. More recently, a meta-analysis of 35 studies involving randomized control trials found that 12.5 % of subjects treated with antidepressants experienced some form of mania. In 2013, the American National Institute of Mental Health warns that: “Bipolar disorder affects approximately 5.7 million American adults, or about 2.6 percent of the U.S. population age 18 and older in a given year.”
Note: Specific reference sources are not listed here. Please contact us if you would like to know the source of any of the information cited above.
PLOS 2010 study on drugs and biolence
On December 15, 2010, PLoS Medicine released a study which showed that, in regard to prescription medications associated with reports of violence towards others, the FDA had received the most reports of violence from the SSRI & SNRI antidepressants (except for Chantix, the smoking cessation drug.) The study listed Prozac as the number 2 drug for violence, and Paxil as number 3.
Antidepressants have been recognized as potential inducers of mania and psychosis since their introduction in the 1950s. Klein and Fink (1) described psychosis as an adverse effect of the older tricyclic antidepressant imipramine. Since the introduction of Prozac in December, 1987, there has been a massive increase in the number of people taking antidepressants. Preda and Bowers 2 reported that over 200,000 people a year in the U.S. enter a hospital with antidepressant-associated mania and/or psychosis. The subsequent harm from this prescribing can be seen in these 5000+ stories.
According to an August, 2013 New York Times article, “fully 1 in 5 Americans take at least one psychiatric medication.”
An absence of controlled scientific evidence
In the Journal of American Physicians and Surgeons, Volume 14, Number 1, Spring 2009, there is a journal article by Joel M. Kauffman, Ph.D., which is titled: Selective Serotonin Reuptake Inhibitor (SSRI) Drugs: More Risk Than Benefits?” In reference to SSRIStories.com, Dr. Kaufmann made the following statement: “Since no clinical trial involving multiple homicides is ever likely to be run, no firmer evidence is likely to be found. Dr. David Healy noted that much of the evidence for suicide and murder came from the efforts of journalists and lawyers.
To read the full article go to the Links page on this site (click the button at the bottom of this page).
A public health problem of epidemic proportions
There is a grave concern among advocates that adverse reactions are greatly underestimated by the public, the medical profession, and the regulatory authorities. Each of these stories in our list can be interpreted as an adverse reaction and in most cases we have highlighted the portion of the article that refers to evidence of bizarre behavioral change consistent with drug reaction. In some stories causation is acknowledged and the juxtaposition of these stories with those where it goes unrecognized as well as the repetition of themes and circumstances is chilling. If indeed medications played a significant role in all these tragedies, then this is a public health problem of epidemic proportions on a global scale.
1 Klein DF, Fink M. Psychiatric Reaction Patterns to Imipramine. Am Journal Psychiatry 1962; 119: 432-438.
2 Preda and Bowers. Antidepressant-Associated Mania and Psychosis Resulting in Psychiatric Admissions. Journal of Clinical Psychiatry 2001: 62: 30-333 National Institute of Mental Health: Health Magazine 2010.
4Thomas J. Moore, Joseph Glenmullen, Curt D. Furberg. Prescription Drugs Associated With Reports of Violence Toward Others. PLoS Medicine: December 15, 2010.
Drug regulation and antidepressants
The U.S. Food and Drug Administration (FDA) Public Health Advisory
On March 22, 2004 the FDA published a Public Health Advisory that states (in part) “Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia (severe restlessness), hypomania, and mania have been reported in adult and pediatric patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and non-psychiatric.”
Black box warnings
On September 14, 2004 the FDA added a Black Box Warning in regard to antidepressants & suicidality in those under age 18. The warning is included as an insert handed out with the drugs:
On December 13, 2006, the Black Box Warning for suicidality was updated to include those under age 25. The Black Box Warning is included in the insert to the drugs and in the Physicians’ Desk reference. Click here to view the Black Box Warning.
Patient medication guide warning
On September 14, 2004 the FDA mandated that pharmacies provide to all parents or guardians for those younger than 18 an Antidepressant Patient Medication Guide. This guide reads (in part) “Call healthcare provider right away if you or your family member has any of the following symptoms: Acting aggressive, being angry, or violent & acting on dangerous impulses.” This Antidepressant Patient Medication Guide also states “Never stop an antidepressant medicine without first talking to a healthcare provider. Stopping an antidepressant medicine suddenly can cause other symptoms.”
In August 2011, the FDA issued a Drug Safety Communication (DSC) stating that Celexa (citalopram) should no longer be used at doses greater than 40 mg per day because it could cause potentially dangerous abnormalities in the electrical activity of the heart. In March, 2012, the FDA updated this warning to warn of QT interval prolongation:
“The U.S. Food and Drug Administration (FDA) is clarifying dosing and warning recommendations for the antidepressant Celexa (citalopram hydrobromide; also available in generic form). In August 2011, FDA issued a Drug Safety Communication (DSC) stating that citalopram should no longer be used at doses greater than 40 mg per day because it could cause potentially dangerous abnormalities in the electrical activity of the heart.
Citalopram use at any dose is discouraged in patients with certain conditions because of the risk of QT prolongation, but because it may be important for some of those patients to use citalopram, the drug label has been changed to describe the particular caution that needs to be taken when citalopram is used in such patients. The revised drug label also describes lower doses that should be used in patients over 60 years of age.”
The use of the phrase “should no longer be used” acknowledges that until August, 2011, the FDA saw no problem with Celexa doses higher than 40 mg. Sadly, this warning came too late for many people who were already dead, because their doctors had no idea that Celexa was potentially deadly for some. This story was posted on RxISK.org: http://wp.rxisk.org/sudden-cardiac-death-jeannies-story/
The United Kingdom Medicines and Healthcare Regulatory Agency (MHRA)
On Dec 10, 2003, Professor Gordon Duff, Chairman – Committee on Safety of Medicines, wrote a letter to UK practitioners that started as follows:
“Reference: CEM/CMO/2003/20, Gateway ref: 2369
SELECTIVE SEROTONIN REUPTAKE INHIBITORS – USE IN CHILDREN AND ADOLESCENTS WITH MAJOR DEPRESSIVE DISORDER
I wrote to you in June and September to inform you that paroxetine and the related antidepressant, venlafaxine should not be used to treat depressive illness in children and adolescents under the age of 18 years. Since then the Expert Working Group of the Committee on Safety of Medicines (CSM) has completed its review of the safety and efficacy of the SSRI class in the treatment of paediatric major depressive disorder.
On the basis of this review of the available clinical trial data, CSM has advised that the balance of risks and benefits for the treatment of major depressive disorder (MDD) in under 18s is judged to be unfavourable for sertraline, citalopram and escitalopram and unassessable for fluvoxamine. Only fluoxetine (Prozac) has been shown in clinical trials to have a favourable balance of risks and benefits for the treatment of MDD in the under 18s…”
Robert Whitaker described how Eli Lilly managed to “prove” that Prozac was effective when, in fact, it was not. However at the time their flawed evidence convinced the UK authorities that use of Prozac for people under 18 had a potential net benefit.
 Anatomy of an Epidemic, Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America, Crown Publishers, 2010, p 230 – 231
Japanese warning on violence
The Ministry of Health, Labor and Welfare in Japan has investigated reports where people on antidepressants have committed sudden acts of violence against others. The agency has decided to revise the warnings on the medication guide to read, “There are cases where we cannot rule out a causal relationship with the medication.”
Myths and misinformation
— by Dr. Peter Gotzsche, blogged by Dr. David Healy January 21, 2014, go to blog
At the Nordic Cochrane Centre, we have researched antidepressants for several years and I have long wondered why leading professors of psychiatry base their practice on a number of erroneous myths. These myths are harmful to patients. Many psychiatrists are well aware that the myths do not hold and have told me so, but they don’t dare deviate from the official positions because of career concerns.
Being a specialist in internal medicine, I don’t risk ruining my career by incurring the professors’ wrath and I shall try here to come to the rescue of the many conscientious but oppressed psychiatrists and patients by listing the worst myths and explain why they are harmful.
Myth 1: Your disease is caused by a chemical imbalance in the brain
Most patients are told this but it is completely wrong. We have no idea about which interplay of psychosocial conditions, biochemical processes, receptors and neural pathways that lead to mental disorders and the theories that patients with depression lack serotonin and that patients with schizophrenia have too much dopamine have long been refuted. The truth is just the opposite. There is no chemical imbalance to begin with, but when treating mental illness with drugs, we create a chemical imbalance, an artificial condition that the brain tries to counteract.
This means that you get worse when you try to stop the medication. An alcoholic also gets worse when there is no more alcohol but this doesn’t mean that he lacked alcohol in the brain when he started drinking.
The vast majority of doctors harm their patients further by telling them that the withdrawal symptoms mean that they are still sick and still need the mediciation. In this way, the doctors turn people into chronic patients, including those who would have been fine even without any treatment at all. This is one of the main reasons that the number of patients with mental disorders is increasing, and that the number of patients who never come back into the labour market also increases. This is largely due to the drugs and not the disease.
Myth 2: It’s no problem to stop treatment with antidepressants
A Danish professor of psychiatry said this at a recent meeting for psychiatrists, just after I had explained that it was difficult for patients to quit. Fortunately, he was contradicted by two foreign professors also at the meeting. One of them had done a trial with patients suffering from panic disorder and agoraphobia and half of them found it difficult to stop even though they were slowly tapering off. It cannot be because the depression came back, as the patients were not depressed to begin with. The withdrawal symptoms are primarily due to the antidepressants and not the disease.
Myth 3: Psychotropic drugs for mental illness are like insulin for diabetes
Most patients with depression or schizophrenia have heard this falsehood over and over again, almost like a mantra, in TV, radio and newspapers. When you give insulin to a patient with diabetes, you give something the patient lacks, namely insulin. Since we’ve never been able to demonstrate that a patient with a mental disorder lacks something that people who are not sick don’t lack, it is wrong to use this analogy.
Patients with depression don’t lack serotonin, and there are actually drugs that work for depression although they lower serotonin. Moreover, in contrast to insulin, which just replaces what the patient is short of, and does nothing else, psychotropic drugs have a very wide range of effects throughout the body, many of which are harmful. So, also for this reason, the insulin analogy is extremely misleading.
Myth 4: Psychotropic drugs reduce the number of chronically ill patients
This is probably the worst myth of them all. US science journalist Robert Whitaker demonstrates convincingly in “Anatomy of an Epidemic” that the increasing use of drugs not only keeps patients stuck in the sick role, but also turns many problems that would have been transient into chronic diseases.
If there had been any truth in the insulin myth, we would have expected to see fewer patients who could not fend for themselves. However, the reverse has happened. The clearest evidence of this is also the most tragic, namely the fate of our children after we started treating them with drugs. In the United States, psychiatrist collect more money from drug makers than doctors in any other specialty and those who take most money tend to prescribe antipsychotics to children most ofter. This raises a suspicion of corruption of the academic judgement.
The consequences are damning. In 1987, just before teh newer antidepressants (SSRIs or happy pills) came on the market, very few children in the United States were mentally disabled. Twenty years laterm it was over 500,000, which represents a 35-fold increase. The number of disabled mentally ill has exploded in all Western countries. One of the worst consequences if that the treatment with ADHD medications and happy pills has created an entirely new disease in about 10% of those treated – namely bipolar disorder – which we previously called manic depressive illness.
Leading psychiatrist have claimed that it is “very rare” that patients on antidepressants become bipolar. That’s not true. The number of children with bipolar increased 35-fold in the United States, which is a serious development, as we use antipsychotic drugs for this disorder. Antipsychotic drugs are very dangerous and one of the main reasons why patients with schizophrenia live 20 years shorter than others. I have estimated in my book, ‘Deadly Medicine and Organized Crime’, that just one of the many preparations, Zyprexa (olanzapine), has killed 200,000 patients worldwide.
Myth 5: Happy pills do not cause suicide in children and adolescents
Some professors are willing to admit that happy pills increase the incidence of suicidal behavior while denying that this necessarily leads to more suicides, although it is well documented that the two are closely related. Lundbeck’s CEO, Ulf Wiinberg, went even further in a radio programme in 2011 where he claimed that happy pills reduce the rate of suicide in children and adolescents. When the stunned reporter asked him why there then was a warning against this in the package inserts, he replied that he expected the leaflets would be changed by the authorities!
Suicides in healthy people, triggered by happy pills, have also been reported. The companies and the psychiatrists have consistently blamed the disease when patients commit suicide. It is true that depression increases the risk of suicide, but happy pills increase it even more, at least up to about age 40, according to a meta-analysis of 100,000 patients in randomized trials performed by the US Food and Drug Administration.
Myth 6: Happy pills have no side effects
At an international meeting on psychiatry in 2008, I criticized psychiatrists for wanting to screen many healthy people for depression. The recommended screening tests are so poor that one in three healthy people will be wrongly diagnosed as depressed. A professor replied that it didn’t matter that healthy people were treated as happy pills have no side effects!
Happy pills have many side effects. They remove both the top and the bottom of the emotions, which, according to some patients, feels like living under a cheese-dish cover. Patients care less about the consequences of their actions, lose empathy towards others, and can become very aggressive. In school shootings in the United States and elsewhere a striking number of people have been on antidepressants.
The companies tell us that only 5% get sexual problems with happy pills, but that’s not true. In a study designed to look at this problem, sexual disturbances developed in 59% of 1,022 patients who all had a normal sex life before they started an antidepressant. The symptoms include decreased libido, delayed or no orgasm or ejaculation, and erectile dysfunction, all at a high rate, and with a low tolerance among 40% of the patients. Happy pills should therefore not have been marketed for depression where the effect is rather small, but as pills that destroy your sex life.
Myth 7: Happy pills are not addictive
They surely are and it is no wonder because they are chemically related to and act like amphetamine. Happy pills are a kind of narcotic on prescription. The worst argument I have heard about the pills not causing dependency is that patients do not require higher doses. Shall we then also believe that cigarettes are not addictive? The vast majority of smokers consume the same number of cigarettes for years.
Myth 8: The prevalence of depression has increased a lot
A professor argued in a TV debate that the large consumption of happy pills wasn’t a problem because the incidence of depression had increased greatly in the last 50 years. I replied it was impossible to say much about this because the criteria for making the diagnosis had been lowered markedly during this period. If you wish to count elephants in Africa, you don’t lower the criteria for what constitutes an elephant and count all the wildebeest, too.
Myth 9: The main problem is not overtreatment, but undertreatment
Again, leading psychiatrists are completely out of touch with reality. In a 2007 survey, 51% of the 108 psychiatrists said that they used too much medicine and only 4 % said they used too little. In 2001–2003, 20% of the US population aged 18–54 years received treatment for emotional problems, and sales of happy pills are so high in Denmark that every one of us could be in treatment for 6 years of our lives. That is sick.
Myth 10: Antipsychotics prevent brain damage
Some professors say that schizophrenia causes brain damage and that it is therefore important to use antipsychotics. However, antipsychotics lead to shrinkage of the brain, and this effect is directly related to the dose and duration of the treatment. There is other good evidence to suggest that one should use antipsychotics as little as possible, as the patients then fare better in the long term. Indeed, one may completely avoid using antipsychotics in most patients with schizophrenia, which would significantly increase the chances that they will become healthy, and also increase life expectancy, as antipsychotics kill many patients.
How should we use psychotropic drugs?
I am not against using drugs, provided we know what we are doing and only use them in situations where they do more good than harm. Psychiatric drugs can be useful sometimes for some patients, especially in short-term treatment, in acute situations. But my studies in this area lead me to 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 creates more harm than good. Psychiatrists should therefore do everything they can to treat as little as possible, in as short time as possible, or not at all, with psychotropic drugs.