Psychiatry’s addiction.

A paper published a few weeks ago in the journal Molecular Psychiatry [1] has stirred up the debate on whether abruptly stopping antidepressants causes withdrawal symptoms. One of the 18 authors is Dr Mark Horowitz, from the UK, co-author of the recently published Maudsley Deprescribing Guidelines [2], while his colleagues are from a range of China’s most prestigious medical institutions. After a most diligent search of the literature and an exhaustive statistical analysis, they concluded that cessation of antidepressants causes withdrawal effects ranging from mild and short-term to severe and long-term in nearly half of people prescribed them. “Why is that news?” you ask. “We all know that.”

Actually, we don’t all know that. There are still large numbers of highly influential people who regard talk of withdrawal effects from psychiatric drugs as “anti-psychiatry propaganda.” In fact, they even managed to replace the loaded word ‘withdrawal’ with the twee term “discontinuation syndrome” [2]. A few years ago, psychologist John Read, professor at University of East London, led a group of professionals and sufferers in challenging the UK’s Royal College of Psychiatrists over their claim that withdrawal effects are minor and fleeting. In a letter to The Times newspaper, the president of the RCPsych and chairman of their psychopharmacology committee had stated:

… in the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.

They had no evidence for this and were eventually forced to withdraw their patently false statement (podcast here). Were they conspiring together to mislead the public (and medical students and everybody else)? I doubt they sat down and plotted how to whitewash psychiatric drugs. Instead, this is just another example of the “conspiracy of the like-minded,” where people who know they’re all thinking the same thing don’t actually need to plot. Mainstream psychiatry has an intense self-interest in spreading the party line that their drugs are predictably safe, effective, harmless and infinitely better than no drugs. You don’t get to be president of a college if you have a record of questioning this. When the UK college finally amended its policy, instead of their usual mantra of “Trust us, there’s nothing to worry about,” they urged:

… other funding bodies to incentivise high-quality research on: …the incidence, severity and duration of symptoms on and after stopping antidepressants, and factors contributing to the individual susceptibility to such symptoms, and how best to manage these symptoms.

That is, sixty five years after the first antidepressants were released, they thought it would be a good idea if somebody paid them to study whether there was any downside to their favourite drugs. 65 years. That’s actually a very long time but it’s only now, when about 15% of the adult population is taking them, that they stir themselves to see if they are addictive. In fact, they needn’t bother with any research, they can take it from the experts, i.e. the people who actually consume them: psychiatric drugs are all addictive.

The recent paper from China concluded about 43% of people suffer withdrawal effects but their sample was limited. They didn’t look at all the people who have been taking them for years, even decades, just because every time they try to stop, they suffer severe withdrawal effects. My experience says it’s closer to 90% but the only way this could be sorted out would be to have a prospective study where people take them for a year or so then the drugs are stopped without their knowing it. Of course, that would be totally unethical although that’s the sort of project they used to do on prisoners, especially in the US (see the Tuskegee experiment). We could, of course, get around that little objection by calling for volunteers from the people who prescribe them but I don’t think we’d get many takers. In the absence of any psychiatrists willing to be the guinea pigs for a change, I think we can accept this as the base position: 

1.      Drugs prescribed for depression are powerfully psychoactive chemicals that induce and maintain a series of largely unknown, short and long term effects on brain metabolism, i.e. they induce a “chemical imbalance”;

2.      When the drugs stop, the brain reverts to its normal (healthy) state;

3.      Following sudden cessation, the process of reversion is experienced as a wide but variable range of withdrawal effects which can be both severe and long-lasting;

4.      Withdrawal effects are not “the mental disease returning” but are of a similar mechanism as standard withdrawal effects from other, known addictive substances.

What are the withdrawal effects from psychiatric drugs? Anything. You name it, people can get it but it is their bizarre quality that says these are not normal symptoms. Physical symptoms include some or all of shaking, twitching, sweating, heart racing, nausea, vomiting, diarrhoea (90% of serotonin receptors are in the bowel), and odd aches and pains. Sensory disturbances are typical, including lights seeming too bright or sounds too loud or ringing in the ears, and a variety of unpleasant tingling or prickling sensations. Headaches are common, with patchy memory, poor concentration and a sense of “brain fog.” Emotionally, people complain of startling easily, irritability, bouts of intense anxiety or feeling low, weak and washed out. Sleep disturbances can be very severe and persistent, with delayed and broken sleep and nightmares. However, the neurological symptoms are the most disabling, including akathisia, poor coordination and impaired balance. People say “My head feels full of electricity,” or “I turn my head and my brain keeps going” but the worst are “brain zaps,” sudden shock-like feelings through the head which can be seriously troubling if the person is driving or operating fast machinery – or picking up a baby.

Withdrawal symptoms can be very frightening. People think they’re going mad or will be locked up. Crucially, they are relieved by resuming the drug, which is true of all withdrawal states. That doesn’t mean patients are taking the drugs to avert the return of depression, it means they’re taking them to avert withdrawal. They’re hooked, in other words. Two questions immediately arise: Why has it taken 65 years until psychiatry takes withdrawal states seriously, and what does it say about the institution of psychiatry that it is not just resistant to the idea its drugs could be damaging, but actively hostile? Coincidently, the week of John Read’s letter to the RCPsych was the same week the president of the RANZCP issued a press release claiming that:

…the prescription of…medications is something that a psychiatrist only ever does in partnership with the patient and after due consideration of the risks and benefits (see here).

Her ludicrous claim was in response to reports of a lecture in New Zealand by Prof. Peter Gotzsche that psychiatric drugs were over-prescribed and had many serious adverse side effects. As I pointed out in a letter to the RANZCP, what the president said was not just a false statement, but she knew at the time she made it, and subsequently when she repeated it, that it was wholly a falsehood (see here for details). She did this for the explicit purpose of preventing anybody seeing the truth and, immediately following my letter, took down the press release to conceal her falsehood (but I’d already posted it on the internet).

The problem is, this way of dealing with the truth is normal for psychiatry. I have a long list of times presidents and other senior officials of the RANZCP have lied in public, and that doesn’t include all the times they have made stupid claims that a moment’s reflection would tell them were wrong. So that brings us to the bigger question, which is not whether antidepressants meet criteria for “addictive drugs,” or even whether we can trust psychiatrists, but this:

What is it about psychiatry that it refuses to accept it could be wrong?

What is it about psychiatry that it not only feels the need to lie about crucial matters, but is so sure it can get away with it? Cardiologists don’t do that. Psychiatry goes to great lengths to conceal the fact that it doesn’t have a theory of mind or a model of mental disorder or any rationale for its forms of treatment beyond “Well, we’ve always done it and it seems to do something so we’ll keep doing it” *. Take, for example, the practice of detaining people and forcing them to accept drugs that psychiatrists know are exceedingly unpleasant and will shorten their lives. Where is the “evidence-base” for this practice? Where are the random controlled trials? There aren’t any but if you question it, all the demons in hell leap on your back and start chewing.

This is the reason they don’t answer objections: they ignore them just because they all know perfectly well they don’t have answers, but nobody is allowed to say that out loud. That is their “conspiracy of the like-minded.” I think I’ve used this quote from Chomsky before:

Still, in the universities or in any other institution, you can often find some dissidents hanging around in the woodwork—and they can survive in one fashion or another, particularly if they get community support. But if they become too disruptive or too obstreperous—or, you know, too effective—they’re likely to be kicked out. The standard thing, though, is that they won’t make it within the institutions in the first place, particularly if they were that way when they were young—they’ll simply be weeded out somewhere along the line. So in most cases, the people who make it through the institutions and are able to remain in them have already internalized the right kinds of beliefs: it’s not a problem for them to be obedient, they already are obedient, that’s how they got there. And that’s pretty much how the ideological control system perpetuates itself in the schools [4, pp. 244-248].

Note that: “They’re likely to be kicked out.” While I disagree with Chomsky’s linguistics [5, Chapter 7], I think he got this right: psychiatry just is an ideology [6] and the sine qua non of ideology is control of the narrative. We will come back to this point from different angles but at this stage, we can take it that mainstream psychiatry has lost control of that bit of the narrative: As a matter of demonstrated fact, antidepressants (and other psychotropic drugs) meet criteria for addictive substances. Before the mainstream organizes its inevitable counter-attack, the drugs need to be brought under control asap, by:

1.      Stop prescribing “antidepressants” for conditions other than depression, e.g. anxiety. The fact that they are widely and indiscriminately prescribed says they are simply non-specific psychoactive drugs.

2.      Restrict prescribing by inserting red tape, e.g. any scripts over six months must be authorized by an independent body (in Australia, that means applying for an authority script, which takes a phone call and is very effective in reducing profligate prescribing rates).

3.      Most importantly, requiring drug manufacturers to provide tapering packages so people can slowly reduce their drugs without risking withdrawal effects. I looked into this some years ago but it went nowhere. Every dose of every drug by each manufacturer has to be authorized by the Therapeutic Goods Administration – at a cost of $160,000 per application. So for an approved manufacturer already selling, say, mirtazapine tablets (15mg, 30 and 45mg), to start providing 2.5mg, 5 and 10mg tablets would cost $480,000. Why would they bother? They’re laughing all the way to the bank now, why make it easier for people to get off their chemicals? But why does it cost so much? It only takes one or two people a few minutes to flick through the application, it’s just a racket.

4.      Establish a central register where patients can list their own withdrawal experiences, rather than relying on doctors to fill in a form on their behalf, which they never do.

5.      Finally, let’s start teaching medical students and trainee psychiatrists the truth: “These drugs are addictive. If you don’t believe it, you can take mirtazapine 45mg each night for six months, watch what happens to your weight and your sex life, then stop them abruptly. And don’t complain about withdrawal effects.”

This way, we might just start to overcome psychiatry’s addiction to spreading falsehoods.

*. A version of the politician’s syllogism: “Something must be done. This is something. Therefore, this will be done.”

References:

1.      Zhang MM et al (2024). Incidence and risk factors of antidepressant withdrawal symptoms: a meta-analysis and systematic review. Molecular Psychiatry https://doi.org/10.1038/s41380-024-02782-4. Published online, Oct 11, 2024.

2.      Lugg W (2021).  The case for discontinuation of the ‘discontinuation syndrome.’ Australasian Psychiatry 56 (1) 94-96. DOI: 10.1177/00048674211043443

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

4.      Chomsky N. The Fate of an Honest Intellectual. Understanding Power, 2002. The New Press.

5.      McLaren N (2024). Theories in Psychiatry: building a post-positivist psychiatry. Ann Arbor, MI: Future Psychiatry Press. ISBN  978-1615998227. Amazon.

6.      McLaren N (2013). Psychiatry as Ideology. Ethical Human Psychology and Psychiatry 15: 7-18. 10.1891/1559-4343.15.1.7