BBC 5 live — the most listened-to BBC radio station in the UK — ran a piece on rising antidepressant prescriptions last Sunday. In short, it aimed to explore why such prescriptions have doubled in the last ten years, and why, in England alone, there were over 63 million prescriptions issued in 2015.
At home I listened to the radio discussion with interest, as earlier that week the producers had called me to discuss possible themes the programme could explore. I do applaud the programme for airing an interview with James Moore, who discussed with passion and clarity some of the harmful side and withdrawal effects of antidepressants. But unfortunately, as I continued listening, it became gradually clear that none of the points I had raised earlier that week (about industry-backed diagnostic inflation and the lax regulation of medicines) were going to be aired as drivers of our prescribing epidemic.
Instead, we heard a very confident GP referring to depression as a “chronic condition” while stating that antidepressants in many instances are “life-saving.” And we heard the President of the Royal College of Psychiatrists alluding to the ‘fact’ that antidepressants are not over- but under-prescribed. Such unsupported claims simply made my head spin, but I shall not test your patience by rehearsing the rebuttals here — I trust you have these already at hand.
What I will do, though, is tell you what I told the producers before the programme was aired, because if they were unable to put these points on record, then I would certainly like to:
“While it is true that vaulting antidepressant prescriptions are partly driven by poor provision for alternative interventions in the NHS,” I told them, “and while it is also true that people are now on these medications for 50% longer than they were some years ago (often because doctors misinterpret withdrawal effects as evidence the original problem has returned, thus reinstating medication), none of this explains why these drugs came to market in the first place, and how they have managed, like i-pads and bubble-gum, to spread rapidly across nations. That kind of contagion needs investment, symbolic capital and powerful patronage. And that’s the story you should tell.”
As our exchange meandered back and forth I was finally asked for a specific example of such patronage — one that applies to the NHS.
The example I chose concerns two of the most powerful questionnaires in the NHS, called PHQ9 and GAD7. Their power is due to their having being used throughout primary care for the last 15 years to enable all GPs to assess whether a person has depression or anxiety and, if so, how severely.
Now, here comes the troubling bit: The major criticism of PHQ9 and GAD7 is that they set a very low bar for what constitutes having a form of depression or anxiety for which a drug should be prescribed. And yet, what the tens of millions of people who have filled in these questionnaires over the last 15 years almost certainly didn’t know is that their NHS distribution was paid for by, their copyright was owned by and their development was undertaken by — Pfizer Pharmaceuticals. Which, incidentally, makes two of the most prescribed anti-anxiety and anti-depression drugs in the UK.
So here we have a company setting the bar very low for receiving such drugs, while at the same time making and selling those drugs — and this has been going on unchecked for fifteen years.
After making these points, the producers seemed genuinely concerned and wanted to know more. And so I continued discussing the facts until they finally declared that a special programme solely on this issue warranted commissioning.
While I certainly agreed with the proposal, my fear of course is that despite good intentions, that probably won’t ever happen. What is more likely to happen, at least in the near future, is that the drivers of our epidemic will continue to be misrepresented by interested parties, misunderstood by a misled public, and roundly miskicked by those guild organisations for whom truth feels like an ‘own goal.’
In an attempt therefore to give voice to what gets little hearing, I have, like so many contributors to Mad in America, been busy with colleagues doing what I can — this time editing a new book on this very topic: the causes and harms of our prescribing epidemic. In conjunction with the Council for Evidence-based Psychiatry, we’ve assembled a team of leading authors (including Peter Breggin, Peter Gøtzsche, Peter Kinderman, Joanna Moncrieff, Sami Timimi and Robert Whitaker) who argue that the primary drivers of this epidemic have little to do with the clinical success of these drugs in rectifying the problems they purport to treat.
Rather, this epidemic has been driven by powerful processes of pharmaceutical sponsorship and marketing, the manipulation and burying of negative clinical trials data, strong financial allegiances between industry and psychiatry, lax and conflicted regulation of medicines, increased diagnostic inflation, poor provision for non-medical alternatives, misused and misleading bio-medical language, and public health policies that increasingly privilege abstract economic and occupational outcomes (such as back-to-work indices) in their framing and management of emotional discontent.
One lesson I have learned from editing this volume, and the sheer power of the chapters included, is that we must keep telling this story, not just because the credibility and integrity of its supporting facts compel us to do so, but because of the social and individual harms this epidemic is continuing to inflict. Indeed, this narrative is a complex one; indeed, it will take more time to unravel than most shows are able or willing to commit — but we must never deter from its telling, for the price of doing so would just be too great.
Congratulations, James, on your cogent and clear comments.
Dr Davies I intend to buy and read your book some time this year. Thank you for writing it.
Here’s another thing regarding the PHQ9 that most people also probably don’t know and it is this: It was interesting to learn that the questionnaire was considered validated by two studies, both of which had the same lead author, a man by the name of R Spitzer. Surprise surprise (not). No wonder the pharmaceutical companies “were delighted”.
Thank you for this fascinating information.
Don’t give up on the BBC though. They may well make a programme. I’m a member of Keep our NHS Public, and have been exasperated with the BBC for years about their health coverage, but they have gone to town on the problems in the NHS recently! They just seem to take a long time to get going.
Whilst I have no doubt that pharmaceutical companies cynically drive the demand for antidepressants, we should not stop educating folk that it is the toxic social /emotional/physical environment they live in, and their response to it, that causes people to get depressed.
James, your message is as reassuring and needs saying, as programmes on the media are disheartening and don’t need saying.
I shall include your news on the web site: http://www.adaptationpractice.org, where the video of the APPG on Prescribed Drug Dependence already appears.
Adaptation Practice offers just such a non-drug, non-medical model, way of dealing with anxiety and depression.
As you know, I am trying to get a book published that is wholeheartedly in support of all you say here.
Thank you for continuing to say it, and with such clarity.
Congratulations to all for keeping this flame alive. Hopefully the following might help.
We are born to thrive, not survive. The problem is that for the most part, individually and culturally, we suffer loss of soul, which is ipso facto depressing, the baseline for most ‘mental illness’
In order to fill that vacuity, always construed as alienating, negative, we struggle to find ways of filling it. Previously we did that with religiosity, currently by materialism, the acquisition of more of everything and a false sense of certainty this affords
Narcotics repress this existential suffering, hence the demand.
However, I guess if war broke out, mass preoccupation with enemy would likely soon put an end to that.
The solution is close in; to learn to not deprecate, wish away, but let go to this emptiness, and without labelling it as depression or this or that, a bit like a plant, sit still with it.
Sure enough, its negative valency changes, and soon, for growth, it dawns on one, one needs/must sit with the ‘dead’ feeling of being rooted in the mud. Hence the Oriental symbol of the lotus.
Close in? To do this, one must learn to fully breathe, through the nose, being fully oxygenated in your relaxed state. The vast majority of folk here only chest breathe, in fight,flight,freeze mode, and lack embodied cognition. As soon as we fully breathe again, like a child, we acquire a sense of sufficiency. Depression is then welcome, rather seen as fundamental of being fully alive!?.
Well written article supporting my own feeling that one day these truths will come out in public and all hell will break loose on a Titanic scale as patients claim compensation for being put on tablets long term that do not do anything but keep worse side effects at bay.
Your book would probably give me a nosebleed as i doubt I’d understand it but i totally support it ?
I havn’t read James’s book yet, but apropos what Stephen has to say here, all hell will break loose once the EU Precautionary Principle gives effect to real toxicological evaluation. The controlling elite must surely be aware of this,…hence Brexit.
I work for an IAPT service- not only do the PHQ9 and GAD7 set the bar low for possible labelling and offer of a drug script they are used routinely within IAPT to measure ‘recovery’. Recovery in this diminished form is whether or not someone scores below a ‘clinical’ score on both measures. These scores are also fundamentally linked to whether the entire service is seen as successful and funded or not with targets being set nationally for ‘recovery and accesses’.
These questionnaires seem almost useless and amount to someone’s best guess as to how they may or may not be feeling in a given moment –many people complete them without really thinking, others people please and get the idea that the scores are meant to reduce, others are fearful of having scores reduce because they see it as linked to much needed dwindling benefits, others are just chronically stuck within a disordered culture.
IAPT services are constantly thinking of ways to manipulate the scores to meet targets so we’re now told to complete them at the end of the session because people often feel a little better at the end of the 50 minute hour rather than at the start.
This temporary experience of feeling better appears to be as much as any talking therapy can offer because it seems clear that it is parts of our culture that is suffering various disorders NOT us. This is largely ignored in favour of pathologising the individual and mostly obscuring the cultural harms through labels, models, drugs, the individual etc helping to keep us all vulnerable to varying degrees from further harms.
When are we going to start investigating and assessing how the culture is harming us? – Why isn’t there a debate about the many and varied harms to body, mind and spirit from jobs/employment for the vast majority of people. What about the harms from education systems, the economy, ideology, class etc. Has self interest run amok?
Thank you for your work on the site and the books – I am part way through the sedated society and its fascinating so far and will hopefully help bring about debate and change.
I am supporting a mental health group and the IAPT is not offering long term therapy for those suffering from depression and anxiety and some are too high functioning and supposedly have too much “insight” to get any help at all. They ambulate from therapy to therapy as stressed out GPS try to offer them what is available as many are not under secondary care and if they are they wait far too long for help whilst remaining medicated. It is not just antidepressants that are the problem but all psychotics, with the view that they should be prescribed for life until as I did decided to take my life back and become the highly functional person that I am instead of the zombie and depressive that I was becoming
Yes we must keep telling this story!
What sickens me is when I see young teenagers coming into my consulting room, having already been prescribed anti-depressants by their G.P.
Its reckless! And so unbelievable that this is allowed to go on.
Don’t give up on this James!!
Over the years I have filled in many such questionnaires and have on several occasions raised serious concerns about them. I’ve struggled with depression (which turns out to have been bipolar) all my life but for many years now I have been unmedicated (I was on Prozac when it first came to the UK and was heralded a wonder drug; it isn’t) and while I am still in distress, I refuse to consider the drugs as they made me worse, not better. Given that talking therapies are now reduced to the two that are cheapest to implement (CBT and “Mindfulness”) and which will, in a couple of years time, be the named causes of much worse distress (this is my Cassandra voice, by the way), I can only see things getting worse rather than improving for most of us.
You are right about things getting worse before they get better.
I have come to the conclusion that talking therapy is not effective and as you say can make things worse. Talking therapy fails because it fails to look at developing skills to investigate the long term health disability.
Mindfulness I have been practising for 40 years. I have been able to experience the NHS version and the Buddhist version. Mindfulness needs to be practised with meditation and must engage with the Buddhist precepts or Christian ten commandments.
Mindfulness takes done psychic barriers which we put up to protect ourselves. If the barriers come down to fast there is mental stress from the environment. The rules of the religious traditions are not there for purpose of being a goody goody but for the purpose of protection from our environment when things go wrong. Things can go wrong hence the need for teachers who have already experienced the problems and thus can advise us in the practice. The medical version of mindfulness does not recognise that problems exist with mindfulness.
One of my problems with Mindfulness-Lite as done via NHS etc, is that it has been excised from a deeper tradition that gives it both context and stability and for me (a person of faith, of sorts) it has struck me as frighteningly empty without that context. CBT troubles me as it does not address either causes or deeper issues and seeks only to modify behaviour which has already been skewed because of those deeper reasons. Doing that will only create worse problems down the line.
I share much of what you expressed. Jung recognised and pioneered the spiritual/religious dimension to recovery and detox, but only touched on breath as Spiritus.
However, so much conventional talk therapy rattles on without firstly addressing the default hyperventilating fight/flight/freeze sympathetic nervous embodied state of the therapist or client; which if well timed, in my experience sets up an a priori compassionate atmosphere for mindful, heart-based cognition.It is interesting that this phenomenon is now recognised as sine qua non in the equestrian field of man/horse relations.
Throughout the health system, sound relating primary interface, self-help intervention- good breathing, good food/ digestion-good elimination is generally discarded in favour of default heady, un-relating, speedy/needy grooming for more pathology/more profit.
Thus the importance for the detox of the positive mantra of ‘going with flow’ ;albeit on a different river,and maybe on a different craft, registering life as a journey, rather than a static cess/pool relegated to meaningless ego indulgence and suffering.
Hi John, it’s good to reflect on your contention that the medical version of mindfulness does not deal with these issues. Since the philosophy and practice of conventional medicine as a whole is sickness driven and does not subscribe to the idea that life is for thriving not in or if itself surviving, and this profits the egocentric status quo, this makes abundant sense.
This is especially observable when in non-polarising meditation we realise how canny the ego/superego becomes in stealing the clothes of good intentions!
My approach is more challenging to head- oriented fight flight freeze responses, calling for embodied cognition as a way of confronting the highjacker and yet presenting it as ‘good medicine’. This is achieved by consciously restoring and redeeming the parasympathetic nervous system by way of pranayama. As you seem to suggest, now the true pilot is in the driving seat, leaving the superego as captain but effectively second in command.
You should have known how the BBC works to squash any dissent on the establishment view. His Smugness has long been one of their pet contrarians, and you should be looking hard at who’s behind the SMC, and SAS, and how they have a free pass to use the BBC as a libertarian propaganda machine.
Thanks James, I bought the book and have been reading it. My son had underlying problem with his over active Thyroids that was not diagnosed until his behaviour became erratic and he was diagnosed as having bipolar disorder and put on anti -psychotic drugs.
As mentioned by you, when he himself stopped taking them his behaviour he became mentally unstable and, as identified by you, was put on stronger medication as justification for his condition and no one ever mentioned that it could be due to withdrawal symptoms.
he has put on 5 stones in weight and is doing his best to control his weight but not succeeding and that is not looking good.
Therefore, I have offered to attend his next appointment with psychiatrist who has told him that he will be on the drugs for the rest of his life.
The thing is they, GP and Psychiatrist, speak with such authority and menace that one fears the repercussions of standing up to them.
I feel empowered now to tackle the medical experts and having read your book know what to expect and ask for.
Thank you for the timely publication.
If you want a really comprehensive questionnaire for medics suggest you check http://www.mindfreedom international…
Thanks Greg for your reply and advice. I am unable to locate the questionnaire.
CHALLENGING THE MEDICAL/PSYCHIATRIC VERSION OF MENTAL ILLNESS
AND IT’S TREATMENT..
SEE WWW. MINDFREEDOM INTERNATIONAL
”You have a “mental illness” that is caused by a biochemical imbalance, or some kind of brain defect or brain disease, or by a genetic predisposition.”
mfi. This is all speculation. Science does not have proof of what causes mental and emotional problems. There is no lab test for any of these conditions. Also, none of these theories are able to explain how many people with mental and emotional problems recover completely.
“The medication we give you will correct your “biochemical imbalance.”
mfi Since no one knows if you have any “biochemical imbalance,” no one can promise to correct it!
. “Recovery from mental illness” does not mean cure. Recovery just means learning to have a better life despite continuing to have the illness.”
mfi There are varying degrees of recovery from mental and emotional problems. Some people recover just enough to improve their life while mental and emotional problems continue. But others go on to have a full recovery, and need no further mental health care. (Others go on to transcend many life problems, they otherwise would not have done, despite the negating effect of psychiatric treatment)
.”Mental health medications are proven to be effective and reasonably safe. When
people who have been diagnosed with a serious mental illness refuse medications, it is because they lack insight into their illness.”
mfi The long term effectiveness of psychiatric medications has not been demonstrated in scientific studies. Even in the short term, some psychiatric drugs may not be any more effective than placebo. Many commonly used medications are quite dangerous, may potentially cause brain damage, and are part of the reason people in the USA public mental health system are dying 25 years earlier than average. Proven non-drug options exist but are not widely offered.)(Those who offer them are fair game for psychiatric and medical criticism and abuse)
.” Because of your diagnosis, you will always have to take psychiatric medications.”
mfi. For each diagnosis, there are people who have gotten off the medications, and then gone on to have very successful lives.
“If you have problems when you quit taking medications, this is proof you need to
continue taking the medications.”
mfi. Problems that arise upon quitting medications are often medication withdrawal effects, and can be minimized by tapering down slowly. Also, if you have been relying on medications to solve emotional problems, you may need to learn effective alternative solutions to these problems in order to accomplish a successful withdrawal.
“ If you really want to be healthy, you will take whatever medication your prescribe
suggests, for the rest of your life.” (This redolent of the idea of the ‘good patient’; properly diagnosed and medicated)
mfi. It’s your choice. It is important not to stop taking medication before you are ready. But for at least some people, getting off medication, even against a prescriber’s advice, may be the best solution. For example, long term studies show high rates of recovery among people diagnosed with “schizophrenia” who have gotten off medication successfully. Getting off medication can mean avoiding long term health risks (including risks of early death) associated with many of the medications.
. “ If you do decide to get off medications, you cannot expect any help from your
prescriber, whose job it is to keep you on your medications”
mfi Unless a court has taken your rights away, you have the right to decide to terminate any given treatment. Since the mental health system got you started on medications, it also has a responsibility to help you terminate that treatment as safely as possible, if that is your choice.(The fact that doctors are not trained to help detoxication, indicates how addicted they are to the pathological model of health)
Greg, the above was useful and his medications have been halved. It was a difficult situation as I encountered a lot of negativity and ‘what if’ and ‘how would you know or identify if he was slipping back’. Sown seeds of doubt but now need support to help him continue and manage any withdrawal problems, if any,
Good news…bless you for hanging in there.
However its important to know this is primarily your sons fate. Its likely that he too unconsciously is using his diagnosis and meds to avoid having to respond to the question…’what happened’ or deeper questions about his identity. e.g clinical experience tells us there is almost certainly an event which triggered initial emotional overwhelm.
Withdrawal symptoms are often normally a return to feeling that anxiety, but of course doc will hold its loss of efficacy of meds..suggest .increase dose. In point of fact successful detoxers say a decrease then, is often a better option! In any event tapering is advisable.
A good detox therapist to see is one who will encourage him to sit with these negative feelings and not ‘give them legs’, regard them as anything but some insight ones greater personality is trying to convey, as ‘something one has to have/suffer in order to know and masure can change’.
He can discover the truth of that by learning to consciously breathe, abdominal and nose breathing. Once one has established a conscious practice of this, one has activated ones parasympathetic nervous system. From here you are never again quite alone, so really cannot negatively suffer the ordinary isolation of overwhelm.
Hope this helps.
Hi Santosh.. A bit more here about what is called Intentional Peer Support. Has the effect of shifting power away from psychiatrist …
Anatomy of Psychiatric Co-Dependence.
“Don’t walk in front of me, I may not follow; don’t walk behind me I may not lead.
Walk by my side and be my friend” Albert Camus
Shared Risk: Redefining Safety
When I was a patient in the mental health system, I heard the language of safety a lot; was I safe?, was I going to be safe, would I contract for safety, etc. etc.
Through these questions, safety came to mean that I was simply agreeing not to do anything to hurt myself or someone else. But what did that leave me with? Frankly, the more safety questions I got, the less I felt reliant on my own abilities to take care of myself. So instead of feeling safe in the world, I felt like a time bomb that could go off at any time.
It also left my clinical relationships with a huge power discrepancy. For example, if I told the truth and was feeling like hurting myself or someone else, the practitioner would feel obliged to make secure arrangements on my behalf. If I lied, I might have all the power, but keeping a secret only made things worse. I’ve had to re-think what safety in my own life means, and it doesn’t mean simply agreeing to keep myself out of harm’s way!
Real safety happens for me in the context of culturally respectful, mutually responsible and trusting relationships. It happens when I’m in relationships where we don’’t judge or make assumptions about each other. It happens when someone trusts/believes in me (even when they’re uncomfortable). Only then I am able to take risks that eventually provide a revolutionary shift in my worldview.
This is how we can begin to redefine safety and talk about shared risk in peer support. The way we get there is proactive rather than reactive. For example, we can talk about what will help the relationship feel safe for both of us in the first contact conversation. We acknowledge (out loud) the extent of our “bottom lines,” and then we figure out together what we will do, should we get to that edge.
We talk about how we each are likely to react when we feel un-trusting or disconnected. We begin to pave the way for negotiating the relationship during potentially difficult situations. But most importantly we talk about power, what it’s like to lose it, abuse it and or balance it. It may be necessary to talk about power imbalances again and again, while struggling together to own what we feel, what we see, and what we need.
These are the kinds of conversations that allow both people to take risks and grow. These are the kinds of conversations that can lead to fundamentally different ways of thinking about help.
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Thanks Greg for your useful information.
Thank you James Davies for publishing what looks to be another excellent expose of what is happening within the mental health system. As another family member/carer said to me recently, “it is hard trying to turn back the tide when so much is stacked against you”. It is indeed and especially when the ocean of mental health propaganda is heavily polluted and engulfs us in its power and control. Nevertheless, we have to clean it up for the sake of humanity and it is by shining an ever brighter light on these issues that we will manage to do it. How else have we ever made change happen when oppressive practices persist ? Keep publishing, filming, protesting in whatever way we can. We shall overcome !
I’ve just read ‘The Sedated Society’. It would be hard to imagine a more powerful critique of mainstream psychiatry. Given that so much information is now available in books and the Internet it is astonishing that the wholesale drugging of the mentally distressed is allowed to continue. Our society’s leaders are without excuse for allowing this outrage.
Two of the developers of the PHQ-9 and GAD-7 were Robert Spitzer and Janet Williams. They were central architects in developing the DSM-III. Spitzer, who died at the end of 2016, was the chair for the DSM-III. It was under his leadership that the DSM was transformed.
Mixed feeling as ever – it is still depressing that so many lives will continue to be lost and that producers are not able to tell the whole reality – that the colleges etc are making so much noise does show they are anxious .about the truth that is spreading into the public domain .