Pass the antidepressants, please.

Perhaps 2024 will one day be seen as a turning point in psychiatry’s long-term project to drug as many of the population as possible. In 2022, a group headed by Joanna Moncrieff in London published a study on the role of disturbances of the neurotransmitter, 5-HT or serotonin, in depression. They concluded:

The main areas of serotonin research provide no consistent evidence of there being an association between serotonin and depression, and no support for the hypothesis that depression is caused by lowered serotonin activity or concentrations. Some evidence was consistent with the possibility that long-term antidepressant use reduces serotonin concentration [1].

This quickly provoked a response from 35 defenders from the “mental disorder is brain disorder” school, including the omnipresent and incomparably conflicted Profs. Guy Goodwin and David Nutt. They tried to dismiss this report, only to conclude: “…it is therefore impossible for the reader to draw valid or reliable conclusions” [2]. But that’s a bit silly as that was the point of the Moncrieff paper: we don’t know as there is no firm evidence. All this talk about serotonin and depression remains just that: talk. However, because antidepressants have such intense side effects, it’s important to know whether they work.

At least we know they work in one respect, that of producing drug dependency. That is, a large proportion of people who take them will have difficulty stopping them, if they can ever stop. Are antidepressants addictive? That depends on your definition of addiction, which can usually be twisted to show that they aren’t addictive: “Aha, but people don’t try to take more and more, as they do with opiates, so that shows they aren’t addictive.” Possibly true but smokers know exactly how many they smoke a day and that hardly changes from one year to the next. It matters because more and more people are being prescribed antidepressants for less and less reason, and increasing numbers of people are taking them in the very long term, for which the drugs were never tested or approved. Most of these people will say: “I can’t stop them, if I do, my depression comes roaring back.” Now that line comes straight from the drug companies, via psychiatrists and general practitioners, but it is little more than an old wives’ tale (with apologies to old wives, who are usually sharper than people who listen to drug companies). However, it’s difficult for ordinary people to argue against it, especially if they tried stopping the drugs themselves and were felled by severe effects. What does psychiatry say? Nothing much:

Despite acknowledgement of antidepressant withdrawal syndromes dating back to the use of the first tricyclic antidepressant, imipramine (Mann and Macpherson, 1959), the topic remains controversial [3].

This is the same group around Goodwin and Nutt who function as watchdogs, ever-ready to savage any reports that threaten their “depression is chemical” narrative. But surely the crucial point is that 65 years after the drugs were introduced, the best they can say is “Er, the topic remains controversial.” Why is it still controversial? I knew at the beginning of my career that people had trouble getting off these drugs, why didn’t all the clever, highly-paid professors investigate it? No answer (Nutt, for one, doesn’t respond to questions he doesn’t like). In fact, we know the answer, it comes from philosopher of science, Thomas Kuhn, who showed that researchers, just like ordinary people, simply dismiss information that doesn’t fit with their preconceptions. It will therefore be interesting to see how they respond to a paper from Joanna Moncrieff’s group last year that asked people for their experience of withdrawing from antidepressants. The paper concluded:

Our findings suggest there is a distinctive antidepressant withdrawal syndrome characterised by a range of emotional and physical symptoms, which can be severe, prolonged and have profound impact [4].

Severe, prolonged and profound. Got it. They showed that symptoms developing after antidepressants are stopped are the same whether the person was taking the drugs for mental health reasons or for a physical reason (usually pain). Therefore, any such symptoms can’t be “the depression roaring back.” While there’s considerable overlap in symptoms, as there always is in psychiatry, the symptoms of drug withdrawal are not the same as depression. If they weren’t depressed before the antidepressants started, it makes no sense to say they suddenly were after they stopped. The Moncrieff study found withdrawal symptoms are “severe” in about half the cases, with major effects on work and on personal and family life. Finally, they are long-lasting: half the cases reported symptoms longer than a year which, because of the study design, was probably an underestimate. In 10% of the cases, withdrawal effects lasted more than five years. Now we see why psychiatry has waited 65 years before studying the side-effects of their favourite drugs: they didn’t want to know (Yogi Berra: “It's amazing what you don't see when you don't look”). Judging from the hostile response from the good professors Goodwin, Nutt and so many others, they still don’t (see my recent letter to the local journal on deprescribing).

However, the drug pushers are probably losing the battle. Following the publication of the Maudsley Deprescribing Guidelines in June last year [5], the mainstream press has now picked up the idea that all may not be well in Camp Psychiatry after all. Readers may recall last year’s drooling interview of Prof. Ian Hickie on how wonderful antidepressants are (Substack February 13th 2024). He was probably lucky to get the air time because now it’s going the other way. The Guardian newspaper has just published a couple of articles on, believe it or not, their own research. They asked their readers to submit their experience of drug withdrawal and the results are not pretty:

Of the 776 readers who wrote in, 711 said they had experienced withdrawal effects, with many describing debilitating symptoms. The most common symptoms described included brain zaps, headaches, anxiety, mood swings, fatigue, dizziness, nausea, insomnia, confusion, difficulty concentrating, flu-like symptoms and heightened sensitivity to stimuli such as touch and noise.

Yes, the study was biased toward the nice people who read The Guardian but why were they taking antidepressants in the first place? Their lives aren’t that bad (in fact, it’s because they’re anxious, but that’s a different story [6]). In a related article, they put the case that antidepressants are being used to mask “toxic social conditions.” I’m sure this happens, especially with women who have no options, but the fact is that most people taking these drugs aren’t living in “toxic” circumstances. They were simply given the drugs when they hit a bit of a rough patch (as we all do from time to time) and then can’t get off them. This is because psychiatry has spent decades shifting the boundary between “normal sadness” and “actual depression” toward the mild end of the scale [7].

Anyway, at last the mainstream press is starting to turn away from the drug pushers to listen to what people actually say about these drugs without the psychiatric industry shouting: “Pay no attention to those withdrawal symptoms, that’s their mental disease coming back. If you want to know about drugs, ask us, we’re the experts.” The widely read mag, Newsweek, has joined the rush with an article saying “Antidepressants work better than sugar pills only 15% of the time.” Wow. That’s not what they were saying 25 years ago, after Prozac was launched. This raises further questions. For example, what about all the people who are given these mind-altering drugs who suddenly find their minds altered, but for the worse? Figures vary but it seems something like one in eight people prescribed antidepressants will experience a bout of agitation/elevated mood, usually (but wrongly) called mania [8]. During this, they feel intensely agitated but also emotionally-numbed and they often do dangerous things. Like: attempt or succeed at suicide, as in a recent report.

On February 25^th last year, 45yo Thomas Kingston shot himself at his parents’ home in SW England. He was the husband of King Charles’ second cousin (i.e. the daughter of the late Queen’s cousin, Prince Michael of Kent), so very much in the Royal Circle. Mr. Kingston had recently been commenced on antidepressants by his GP over “work issues,” and showed no signs of distress when he had lunch with his parents an hour before he died. Anybody who works in mental health will be aware that this happens. The difference this time is the coroner’s finding, and in the publicity the case has been given. Cr Katy Skerrett determined:

The evidence of his wife, family and business partner all supports his lack of suicidal intent ... He was suffering adverse effects of medication he had recently been prescribed.

Oh boy. It’s one thing when commoners top themselves, something else again when the drug companies manage to bump off a member of the elite. From the publicity given this incident, I suspect the family are very angry, and rightly so. The same applies to homicides. A significant number of people who carry out mass shootings were taking psychiatric drugs at the time or have been diagnosed “depressed,” which strongly indicates they were taking drugs. However, there is no reliable data base to deal with just this point. In the Louisville, Kentucky, shooting of September 14^th, 1989, in which eight people were killed, the assailant, Joseph Wesbecker, had been prescribed fluoxetine (Prozac) shortly before the incident. Subsequently, the survivors and relatives sued Eli Lilly, the manufacturers, but the case settled. It later emerged Lilly had paid the claimants $20million to terminate the case. Similarly, in the three months before she suddenly murdered her three children, Lindsay Clancy had been prescribed 13 different psychiatric drugs. Her precipitous action has since been blamed on post-partum psychosis (the baby was eight months old), not on the drug cocktail.

There are two points to note. First, DSM-5 specifically states:

A full manic episode that emerges during antidepressant treatment (medication, ECT) but persists at a fully syndromal level beyond the physiological effect of that treatment is sufficient evidence for a manic episode and therefore a bipolar I diagnosis [p124, repeated p133].

That is, don’t blame our drugs. In fact, they’re twisting the truth: they use the expression “physiological effect” to mean “still in the blood.” However, psychiatric drug effects persist long after the drug has cleared, because that’s what they do. Sudden, unexpected suicides in people taking antidepressants, especially just started, are dealt with the same way: “Oh, that was his mental illness. He should have had more drugs, not less.” Second, the antidepressant nefazodone (Serzone) was released in 1994 but withdrawn after ten years as it occasionally caused severe liver damage, leading to a dozen deaths in the US. The incidence was about one in every 250,000-300,000 patient years, i.e. if 100,000 people took it for three years, then you would expect one death. That’s not a lot but the data bases picked it up and it was enough to get the drug withdrawn.

If antidepressants are causing suicides and/or homicides, either when the drugs are started or, equally dangerously, when they are abruptly stopped and cause withdrawal symptoms, then we need to know. That means there should be a nation-wide database of all people who either die by suicide or who commit major offences while on psychiatric drugs. As small, isolated populations with highly-developed services and infrastructure, Australia and New Zealand would be ideally suited to such a study. As the information is already routinely collected in coronial enquiries or court reports, all that we need is a bit of cash to set up a national database. A bit of cash and the political will. It won’t come from mainstream psychiatrists: don’t expect anybody who says things like “…it is therefore impossible for the reader to draw valid or reliable conclusions” [2] to support the project. Governments won’t do it because the people who advise them are beholden to the drug companies, who would much rather nobody looked for fear of what they might find.

In any event, the tide may be turning. Time may show we have reached “peak antidepressants.” Now is the time to apply pressure, because the mainstream will be pushing to take back control of the narrative. As they do.

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PS: Bob Whitaker has just posted a lengthy article on a notorious psychiatric scam, showing how the mainstream media were complicit in allowing it to continue long after it was exposed:

Summing up the STAR*D scandal: the public was betrayed, millions were harmed, and the mainstream media failed us all.

https://www.madinamerica.com/2025/01/stard-scandal-betrayed/?mc_cid=9e161f80bc&mc_eid=72bc5ea421

Strongly recommended. His attention to detail is legendary.

References:

1. Moncrieff, J., Cooper, R.E., Stockmann, T. et al. (2022) The serotonin theory of depression: a systematic umbrella review of the evidence. Mol Psychiatry Published online July 20th 2022. https://doi.org/10.1038/s41380-022-01661-0

2. Jauhar S and 35 others (2023). A leaky umbrella has little value: evidence clearly indicates the serotonin system is implicated in depression. Molecular psychiatry 28:3149 – 3152.https://www.nature.com/articles/s41380-023-02095-y

3. Jauhar S et al (2019). Antidepressants, withdrawal and addiction: where are we now? Journal of Psychopharmacology 33(6) 655–659. https://doi.org/10.1177/0269881119845799

4. Moncrieff J, Read J, Horwitz M (2024). The nature and impact of antidepressant withdrawal symptoms and proposal of the Discriminatory Antidepressant Withdrawal Symptoms Scale (DAWSS). J Aff Dis Reports. https://doi.org/10.1016/j.jadr.2024.100765

5. Taylor D, Horowitz M (2024). The Maudsley Deprescribing Guidelines. London: Wiley-Blackwell.

6. McLaren N (2018). Anxiety: The Inside Story. Ann Arbor, MI: Future Psychiatry Press.H

7. Horwitz AV, Wakefield JC (2007). The Loss of Sadness: how psychiatry transformed normal sorrow into Depressive Disorder. New York: Oxford University Press.

8. Tondo L, Vasquez G, Baldessarini RJ (2010). Mania associated with antidepressant treatment: comprehensive meta-analytic review. Acta Psych Scand 121: 404-14. doi: 10.1111/j.1600-0447.2009.01514.x.

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