David Nutt and colleagues1 represent a brand of psychiatry that wishes to keep its eyes firmly shut when evidence of harms and lack of effectiveness of favoured biological treatments are found. It is therefore unsurprising they take issue with the Council for Evidence-based Psychiatry for publicising evidence that rarely gets discussed; evidence that would enable people to make properly informed decisions about whether they will benefit from drug treatments that research shows can cause serious, persistent adverse effects.
We believe in the importance of psychiatry, but also in the dictum of “first do no harm”, and in the role that critical thought has in genuine scientific progress. We are therefore tired of the intellectual malaise, corruption, and indifference some sections of academic psychiatry seem to have developed. We are also deeply concerned about the potentially devastating impact this blindness is having on the lives of millions of people who have been on the receiving end of a pharmaceutical revolution borne out of good marketing manipulating poor science.
The record of this brand of psychiatry is poor. As David Kingdon and Allan Young2 have put it: “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 the future.” Similarly, Arthur Kleinman3 has predicted the current biology-based model of academic psychiatry will be ruinous to the profession due to its consistent failure to deliver.
Peter Gøtzsche, director of the Nordic Cochrane Centre, has dealt with the counter-evidence on the specific issue of antidepressant prescribing.4 He shows how Nutt and colleagues have succumbed to the tendency to minimise harms and exaggerate benefits in a way that puts patients at risk and leaves them without access to balanced information. And in terms of stigma, the evidence consistently finds that it is the idea that mental illness is like any other illness that is most likely to lead to stigma5 and so to more potential pain and suffering for patients.
Throughout its history, psychiatry has been slow to admit the negative effects of its drugs, as is well documented in the case of antipsychotic drugs and tardive dyskinesia. By branding severe adverse reactions to antidepressants as unexplained medical symptoms distorted by the incentive of litigation, Nutt and colleagues’ perpetuate this tendency and pour scorn on the experience of patients and their families.
The Council for Evidence-based Psychiatry finds this insulting and shameful. British withdrawal-support charities report alarming numbers of people suffering disabling symptoms for multiple years following withdrawal from antidepressants. We surely need this issue properly researched rather than summarily—and offensively—dismissed. The future of more humane care and a properly scientific profession depends on our willingness to engage with such uncomfortable realities.Dr Sami Timimi Dr Philip Thomas Dr James Davies Dr Peter Kinderman
All authors are members of the Council for Evidence-based Psychiatry. We declare no competing interests.
CEP’s letter can be seen here on The Lancet Psychiatry website (no registration required):
The original article by Nutt et al can be seen here: