Translation of two articles published in Danish newspaper Politiken 30 August 2015
Sunday, 30 August 2015
By Lars Igum Rasmussen
Professor: Drug consumption in psychiatry is harmful
The consumption of drugs is “insanely high,” warns known professor. It should be substantially reduced since the drugs do more harm than good, he says.
Drugs used to treat mental illnesses such as schizophrenia, depression and anxiety should – virtually – be dropped. The medicine is harmful, injures and destroys more than it helps, according to the respected but controversial professor of clinical research design and analysis at the University of Copenhagen, Peter Gøtzsche:
‘The use of psychotropic drugs in psychiatry is insanely high. The drugs kill people and create disease; they do not solve problems.’
In his book “Deadly psychiatry and organised denial,” which will be released tomorrow, he argues that the use of drugs to treat mental disorders should be reduced by 98 per cent.
Instead, there should be a greater focus on psychotherapy, and all forced treatment must be stopped. Medication should only be used in acute, severe psychosis, and only in short-term treatment.
440,000 people received a prescription for antidepressants in 2013. According to Gøtzsche, 1 in 7 Danes can be in lifelong medical treatment with the current total consumption of psychotropic drugs.
The Danish Health and Medicines Authority is ‘indeed aware of the challenges of a high consumption of psychiatric drugs,’ says Søren Brostrøm, head of Hospital Services and Emergency Management, in a written comment:
‘For example, for groups such as young people, the elderly and people with dementia, where there is no good evidence that antidepressants work, and where the consumption of drugs has probably been too high. ‘
However, he adds that the solution is not ’a strong reduction in the use of the drugs, as suggested by Gøtzsche. There is a need for both pharmacological and non-pharmacological drugs.’
Knud Kristensen, National Secretary of MIND – the national association for the mentally ill – calls it a ‘relevant and welcome debate.’
‘But it is problematic when the style becomes so bombastic that it is said that the drugs kill people. We have many members who say they would not have been alive were it not been for the medication,’ he says.
Thorstein Theilgaard, Secretary General for Better Psychiatry – an association advocating for relatives and families of persons with mental illness – believes that medicine cannot and should not stand alone:
‘Unfortunately, it stands alone a little too often in psychiatry today. We need more tools in the psychiatric toolbox.’
According to professor of psychiatry Poul Videbech, it is frivolous only to talk about overtreatment. He is convinced that some people who get antidepressants, for example because of stress and temporary crises, shouldn’t have them:
‘But I also know from good, solid studies that very sick people who should take antidepressants don’t get them.’
He doesn’t like the bald statements from Professor Peter Gøtzsche: ‘There are sick people who get confused about what is right and wrong when the discussion becomes so bald.’
In his book, Peter Gøtzsche writes that antidepressants ‘probably don’t work,’ are harmful to many and cause deaths. Antipsychotics ‘kill and destroy lives.’ Drugs for dementia don’t work. ADHD drugs only work on a short-term basis, but ‘are directly harmful when used long-term.’
‘We no longer beat our children but destroy their brains with these drugs. There will always be inevitable conflicts between children and adults. And there are children who are not as well adjusted as others think they should be. But they should not be put in a chemical straitjacket. ADHD medication is today’s cane,’ says the professor.
firstname.lastname@example.org Interview with Peter Gøtzsche
__ __ __ __
Sunday, 30 August 2015
Pages 8 and 9 in PS
By Lars Igum Rasmussen
‘The industry’s marketing is very, very effective. For example, it has led doctors to believe that antidepressants are effective drugs. It is not the case at all.’
The mentally ill should hardly be treated with psychotropic drugs. The drugs are far more dangerous than acknowledged. And the psychiatrists’ diagnoses are pretty arbitrary. We should adopt a totally new view on people with mental disorders, says the controversial professor Peter Gøtzsche who publishes a new book tomorrow.
Psychotropic drugs interview
‘An infinite number of bodies are buried in healthcare that people hope will never be discovered. That is why it is very, very unpopular when I dig the bodies up.’
Says one of the most controversial, but also academically respected, contemporary Danish physicians, Peter Gøtzsche, Doctor of Medical Science and professor of Clinical Research Design and Analysis at the University of Copenhagen.
In his new book, “Deadly Psychiatry and Organised Denial,” which is released at the same time in Danish and English, Peter Gøtzsche makes a confrontation with the whole of psychiatry. He criticises psychiatric diagnoses, which are being made by using ‘simple checklists.’ According to the professor, the arbitrariness leads to a huge consumption of psychotropic drugs, which often harm the patients and don’t work at all, as doctors otherwise say.
In 2013, for example, 440,000 Danes redeemed a prescription for an antidepressant drug. According to Peter Gøtzsche, the total Danish consumption of psychotropic drugs is so high that one in seven Danes could be in treatment every day from cradle to grave.
In the United States, antipsychotic drugs were the most sold drugs in 2009 while antidepressants came at the fourth place.
Although Peter Gøtzsche’s scientific arguments about the effects of the drugs and their side-effects are in direct conflict with the established attitude to psychotropic drugs shown by respected Danish and international psychiatrists, the book is really intended to be an invitation to a scientific debate with the established psychiatric community, both in Denmark but primarily in the United States, which sets the tune in relation to how the psychiatry community perceives patients and how they use drugs.
The fact is that psychiatric diagnoses often comply with the American Psychiatric Association’s diagnostic manual ‘DSM,’ ‘Diagnostic and Statistical Manual of Mental Disorders.’ The controversial checklist system where doctors tick boxes to see if the patient has a psychiatric disorder published a third diagnostic manual in 1980. The fourth edition was published in 1994 and had 374 – or 26 per cent more – mental disorders listed. The fifth edition was published a couple of years ago.
‘I have now provided my documentation in the book. I do not expect that everyone will agree with the way I interpret the scientific literature. But I hope that we can have a serious scientific debate about these things,’ he says and continues:
‘Because no matter how you turn and twist the scientific literature and at the same time look at the gigantic consumption of psychotropic drugs, you should come to the conclusion: the way in which we use psychotropic drugs today does more harm than good. We should react very differently to citizens with mental health problems. Drugs are not the solution but part of the problem.’
Broadly, the conclusion is the same for each disease area: scientific research – he calls it ‘mainly pseudoscience’ – does not find that these various drugs are efficient such as psychiatrists otherwise say to their patients.
Gøtzsche believes he has documented that psychiatric drugs generally do more harm than good. And both psychiatrists and general practitioners often give people rather arbitrary diagnoses and forget to give them a tapering plan when they write a prescription.
Therefore, according to Peter Gøtzsche, 98 per cent of the consumption of drugs should be removed.
The focus should not be on diagnosis, medical treatment, chemical substances and their effect on the brain, but on people who have a mental hardship and their stories.
With the book, he wants to ‘poke a hole in psychiatry’s official balloon so big that it stays on the ground.’
‘Biological psychiatry is based on a series of misunderstandings and myths, which do not hold water on closer scrutiny. One of the great myths, which more than half the patients have been told, is that they suffer from a chemical imbalance in the brain. The drug will then correct the imbalance, and often they are also told that the drug is like insulin to a patient with diabetes, i.e. you give your body something it is lacking. But it is a very harmful myth,’ says Peter Gøtzsche.
Peter Gøtzsche is a specialist in internal medicine and professor of Clinical Research Design and Analysis at the University of Copenhagen. He teaches how scientific research should be carried out properly, and he is one of the leaders in the field worldwide.
In 1993 he co-founded The Cochrane Collaboration and established the Nordic Cochrane Centre, which is situated at Rigshospitalet (Copenhagen University Hospital). The Cochrane Collaboration is a network of 34,000 medical researchers in more than 100 countries whose main task it is to assess the scientific research critically.
He has published more than 70 scientific articles in the five major medical journals and has been cited more than 15,000 times by other researchers.
He has, time and again, through his scientific analyses, stepped forward and given his honest opinion – and time and again he has been exposed to verbal beatings, but he also has been instrumental in obtaining changes in the healthcare system.
When women today, in Denmark and in a large number of other countries, are informed much more clearly about several negative effects of screening for breast cancer, mammography screening, it is solely due to Peter Gøtzsche’s scientific work. Several countries, e.g. the United Kingdom, have reconsidered their screening program as a result of his research. And he believes that mammography screening will be phased out in his lifetime, globally.
He has documented that systematic health checks do not save lives. He has documented how neither chemicals nor mattress covers help allergy sufferers against dust mites, which manufacturers and doctors treating people for allergy did not like. Through political contacts and years of persistent work, he has achieved to make the European Parliament arm wrestle with the pharmaceutical industry and won.
Now, the industry has to publish all research data, even if the conclusion is negative for the company. Previously, this data was hidden by the pharmaceutical industry deep in a drawer.
In 2013 he went ‘all in’ and wrote that the pharmaceutical industry makes use of mafia-like methods, in the controversial book “Deadly medicines and organised crime – How big pharma has corrupted healthcare.”
It cemented his sainthood in those parts of the medical profession that are critical towards the large drug consumption, in patients’ associations and among people with strong anti-pharma attitudes.
In 2014, the psychiatrists in Denmark dropped their prescription pen when the Danish newspaper Politiken published the feature article “Psychiatry gone astray” by Peter Gøtzsche, in which he strongly criticised doctors’ use of psychotropic drugs. The new book is Gøtzsche’s scientifically documented answers to the massive debate – both domestically and globally – that his points led to.
The psychiatrists in Denmark and their scientific association remonstrated with the professor over this and Gøtzsche calls the first few months of 2014 ‘a pure witch hunt after my person.’
According to Peter Gøtzsche, his critics tried to have him removed. How could anyone protect a man who meant something as controversial as ‘our citizens would be much better off, if we removed all psychotropic drugs from the market because doctors are unable to handle them?’
The row ended on the table of the then Minister of Health, Astrid Krag (Socialist People’s Party). She said that his point of view ‘will contribute to trivialisation and a reduction to a state of stupidity.’ She said publicly that Peter Gøtzsche and the Nordic Cochrane Centre – which is financed by the government, and which he had spent his life building up – were not identical. A point of view the severely criticised professor considered a threat of firing.
The media hurricane has not caused Peter Gøtzsche to change a comma in his views on and criticism of psychiatry and the doctors’ widespread use of psychotropic drugs.
‘Why should I? What I wrote at the time was true. I am not the only one with this point of view. Many sensible psychiatrists, doctors and other skilled scientists say the same. But we are up against the established system. I recognise that,’ says Peter Gøtzsche and continues:
‘In the book I now substantiate in great detail that if doctors do not improve in the way they handle psychoactive drugs, and prescribe them much less, and at the same time have a tapering plan prepared, many patients will be on drugs for the rest of their lives because they have been told that they have a chemical imbalance in the brain or will be brain damaged if they do not take the drugs. That is why I keep going,’ he says and refers to the 378 pages and hundreds of references to scientific studies and other literature described in the book.
Peter Gøtzsche is well aware of the fact that the artillery will once again be directed against him.
‘My wife and I have talked about it but we have agreed that it is the right thing to do. And why on earth should I not be allowed straight talk? This is the conclusion I have reached after scrutinising the science. There is a lot of evidence that shows that in particular leading American psychiatrists are corrupt to a substantial extent. They allow the pharmaceutical industry to manipulate with the clinical trials so that they come to wrong conclusions,’ he says.
In the book, Peter Gøtzsche scrutinises the treatment of the major psychiatric disease areas after having studied the scientific literature – as well as the non-published data, which the pharmaceutical industry has discarded over the years because the drugs did not show the desired effect.
‘This is data, which the psychiatrists rarely examine closely,’ he says.
‘Imagine if you tested healthy people for cancer with a test that gave a quarter of them an erroneous diagnosis, which led to treatment with chemotherapy for a cancer that wasn’t there. We wouldn’t allow such a poor test to be used in any other area of healthcare except psychiatry.’ From the book “Deadly psychiatry and organised denial”
Throughout the interview, Peter Gøtzsche uses the medical terms antipsychotics and antidepressants, although it is one of his important points in the book that exactly this use of medical terms is due to the pharmaceutical marketing, which the doctors have accepted.
‘Words like antipsychotics suggest of course that these drugs have a specific effect on psychosis, just as antibiotics actually have a specific effect on bacteria. Therefore, words like antipsychotics are totally misleading. The drugs do not have any specific effect on psychosis. The medicine affects the brain and calms the patients down. Not only their psychotic thoughts, all thoughts. Therefore, people medicated with antipsychotics still have their wild thoughts, but to a lesser extent. And for this reason, former patients also describe their condition as if they have been turned into zombies. The medicine is not good in itself. And doctors cannot handle it,’ he says.
For more than half a century, psychiatry has tried to find biological explanations for the mental sufferings people have endured at all times. With no luck, he says. Several hypotheses, for example that depression should be caused by a lack of serotonin, have been shot down.
Currently, no mental disorders can be detected, confirmed or excluded through blood samples, X-rays or other tests.
All psychiatric diagnoses are based on the patients’ symptom clusters. Therefore, a doctor or psychiatrist may diagnose a patient with a mental illness when a number of criteria are met. Criteria may change over time, producing diagnostic uncertainty, according to Peter Gøtzsche.
Until a few decades ago, homosexuality was listed as a mental illness but then it was agreed that it was a natural part of human nature. Today, the diagnosis has been removed from the diagnostic manual of mental disorders.
‘I criticise indeed the current psychiatric diagnostic practice, which is completely out of control. It takes so little to be diagnosed with a mental disorder according to the checklists used by psychiatrists and general practitioners that many of us could get one or more psychiatric diagnoses,’ says Peter Gøtzsche.
He refers to an American study claiming that 10 per cent of American adults are suffering from a depression at any given time.
‘No-one really believes this, do they? And it isn’t true either, as it hardly requires anything to be diagnosed with depression. If you in 8 days out of 14 have little pleasure in doing things you usually do, and have an additional symptom such as decreased appetite or sleeping problems, you suffer from a depression. But a young man whose girlfriend has left him will through all 14 days have less pleasure in doing the usual things and will have loss of appetite and poor sleep. He is feeling miserable and can be diagnosed with depression. It doesn’t make sense.’
Still, Peter Gøtzsche says, he has approached ‘the issue with an open mind.’ ‘I would become very happy if it turned out that a specific biochemical brain defect caused a mental disorder, and that we would then actually be able to cure the patients with drugs that correct the brain defect. I have nothing against drugs that works well. But psychiatry isn’t there yet.’
‘Psychiatry’s almost manic obsession with ineffective, addictive drugs has led to a disaster in public health so big that nothing I have seen in other areas of medicine comes close.’ From the book “Deadly psychiatry and organised denial”
‘Psychotropic drugs are not particularly specific and they cause huge problems for patients in the long term, because patients become addicted and have difficulty stopping. And some are not able to stop because they experience rather pronounced abstinence symptoms, although they are tapering slowly,’ says Peter Gøtzsche.
According to Gøtzsche’s interpretation of several studies, the drugs make matters worse. If the widespread use of psychotropic drugs had the same effect as insulin for diabetes, fewer people would need early disability pensions when they were in medical treatment, based on the thesis that psychiatric drugs cure people.
‘But no, the exact opposite has happened. In all countries where this has been studied, the number of persons who are outside the labour force because of mental disorders has exploded. And it goes hand in hand with the consumption of psychotropic drugs that has skyrocketed over the past 30-40 years,’ he says.
Hundreds of thousands of Danes take psychotropic drugs with pleasure. They believe that they have a positive effect of their medical treatment, which you want to reduce. How can you know better than them?
‘It is the spontaneous course of the disease that they confuse with an effect of the drug. You are sad, see the doctor, are diagnosed with a depression, and are prescribed an antidepressant. And then you feel better within a few weeks. It is therefore understandable that doctors and patients interpret improvements as a positive response to the antidepressant. Everyone seems to forget that if the doctor hadn’t done anything, but just said that it would become better within a few weeks, most of the patients would have felt better without treatment, avoiding the mistake of believing that it was a positive effect of the drug.’
It could also be the positive effect of the drug?
‘Large randomised trials including more than 100,000 patients, where one group received an antidepressant and the other group a placebo, show that it is doubtful whether antidepressants have any real effect. I document this in my book.‘
Why would psychiatrists want to treat patients with drugs if they have no effect at all?
‘Among other things because people do not know about the unpublished research. I have looked more deeply than just into the published research. I had access to a number of unpublished data that I describe in my book and which shows, for example, that antidepressants cause far more suicides than psychiatrists realise. The second reason is that drug marketing is very, very effective. It has convinced doctors to believe, for example, that antidepressants are effective drugs. They aren’t. Not at all.’
Peter Gøtzsche doesn’t deny that psychiatric drugs could be useful for a few patients, although the average effect, according to the professor, is close to being non-existent.
‘When the average effect of a treatment is close to zero, there might be some who benefit. But on the other hand this would mean that others will experience harmful effects, otherwise the average effect could not be close to zero. And the negative impact is experienced by those who feel trapped under a cheese-disk cover, have difficulty feeling pleasure, have sexual problems and other things that affect the quality of life. And if the drug has a real effect on a few patients, then the psychiatrists are not able to identify the relevant patients from their doubtful diagnostic questionnaires.’
When will psychiatric medication make sense?
‘In acute situations, where the patients are tormented and up in gear and cannot sleep, e.g. because of an acute psychosis. They should not be forced into treatment. If you take it easy and try to establish a relationship with the patient that builds on trust, the majority of these severely disturbed patients will ask for a sedative. Then we could give them the old sedatives, benzodiazepines, but only for a very short period. Studies have shown that benzodiazepines are more effective to calm down patients than antipsychotics, which are quite dangerous drugs, but for some reason psychiatrists choose to prescribe these drugs instead. I don’t understand why.’
Peter Gøtzsche’s criticism is addressing both the drugs themselves and the doctors handling the medication.
‘The worst thing is – and this often happens – that when a patient deteriorates on one antipsychotic, the psychiatrist increases the dose of the drug instead of tapering it, or uses two, three or even four other antipsychotics on top of the first one, which is contrary to the Board of Health’s recommendations. So they make matters worse. And they run a risk of killing the patients with the drugs.’
‘I am used to being called provocative or controversial, which I take to mean that I am telling the truth.’ From the book “Deadly psychiatry and organised denial”
Why do you put all psychiatrists in the same boat when you talk about ‘organised denial’ with ‘loose diagnoses and a loose hand on the prescription pad’?
‘I cannot write in every sentence that it does not apply to all psychiatrists. There are also excellent psychiatrists who do the right things. But remember that those who steer psychiatry from the top support the mythology they have helped create. And when very reliable research comes forward that says the opposite, they refer to unreliable research supporting their mythology. Instead of changing direction and say “sorry, we were wrong.” It doesn’t happen.’
You never see a professor of diabetes give statements about allergies, or a professor of schizophrenia comment on depression. How come you have strong opinions on a wide number of issues where you are not a specialist?
‘Please note that my views build on my studies of other people’s research. It doesn’t come out of thin air. In my entire life, my expertise has been to evaluate research articles critically. I am Professor of Clinical Research Design and Analysis. Therefore, I don’t speak about issues I know nothing about but about issues I have studied. And you don’t need to be a psychiatrist to assess the psychiatric pseudoscience.’
Now that you speak so directly, you run a risk that patients on their own or after pressure from relatives stop treatment.
‘It is very, very important that no-one stops psychiatric drugs abruptly. There must be a slow tapering guided by a professional and with support from family and friends. It is very important that no-one stops cold turkey. It can be life-threatening.’
‘When we respect the patients and treat them as reasonable beings, they will respect themselves, which is the first important step towards healing.’ From the book “Deadly psychiatry and organised denial”
According to Peter Gøtzsche, the problem with drugs when patients seek a doctor for their mental challenges is that drugs lock the patient into precisely the role of a patient.
Patients change their behaviour and no longer see themselves as the key to the solution of their negative, troubled and tormented mind.
‘They hear that they have a chemical imbalance in the brain and they therefore wait for the drugs to cure the defect, like insulin helps for diabetes.’
Peter Gøtzsche therefore believes that citizens above all should try to avoid that doctors put a psychiatric diagnostic label on their backs, as it virtually always means psychiatric drugs – along the way frequently more than one kind of medication simultaneously.
Instead, doctors should try to understand their patients and here psychotherapy is an effective solution, he says repeatedly.
In a Feature in Politiken, the country’s psychiatric professors wrote that ‘in recent years, psychotherapeutic methods have become more effective. And there are many indications that we will see further achievements.’ Psychiatry embraces psychotherapeutic methods. Don’t you hold a prejudiced opinion that the psychiatrists only prescribe drugs?
‘No, certainly not. The empirical studies I have reviewed show that it is very difficult to visit a psychiatrist without getting a prescription for a psychiatric drug. There are really many psychiatrists that do not learn psychotherapy. This they did 40 years ago, but then came an increased focus on biological psychiatry, which described chemical imbalances and a quick fix with a drug. Since around 1980, it has gone astray, which is also reflected in the consumption of psychotropic drugs that constantly rises, also because the industry constantly invents new psychiatric diagnoses so that they can sell more drugs. It is not psychotherapeutic methods that characterise psychiatry. But I’m glad that leading Danish psychiatrists have written positively about psychotherapy, as this is the way to go.’
Prescription pills are Britain’s third biggest killer: Side-effects of drugs taken for insomnia and anxiety kill thousands. Why do doctors hand them out like Smarties?
- 80 million prescriptions for psychiatric drugs are written in UK every year
- Psychiatric drugs are the third major killer after heart disease and cancer
- Professor Gøtzsche reveals the scale of the issue in a new book
- Luke Montagu, 45, heir to the Earl of Sandwich, was wrongly prescribed anti-depressants which took him seven years to detox from
Published: 01:10 GMT, 15 September 2015 | Updated: 01:10 GMT, 15 September 2015
Soaring drug use, a growing number of addicts, far too few clinics to treat them and a rising death toll. This might sound like a scene from an impoverished country run by drug cartels – but it is, in fact, the day-to-day reality for NHS patients who are prescribed psychiatric drugs to treat anxiety, insomnia and depression.
More than 80 million prescriptions for psychiatric drugs are written in the UK every year. Not only are these drugs often entirely unnecessary and ineffective, but they can also turn patients into addicts, cause crippling side-effects – and kill.
For instance, antipsychotics, commonly given to dementia patients to keep them quiet, raise the risk of heart disease, diabetes and stroke. Psychiatric drugs also make falls more likely, and breaking a hip can shorten life significantly, while some antidepressants are linked to a potentially deadly irregular heartbeat.
And the death toll from these pills has been grossly underestimated. As I reveal in a new book, Deadly Psychiatry And Organised Denial, the true figure is terrifying: according to my calculations, based on data from published and unpublished sources, for psychiatric drugs are the third major killer after heart disease and cancer.
As an investigator for the independent Cochrane Collaboration – an international body that assesses medical research – my role is to look forensically at the evidence for treatments.
Previously this has led to me challenging widely-held assumptions about the benefits of breast cancer screening (I’ve calculated that every year in the UK, thousands of women undergo unnecessary treatment because of overdiagnosis), GP health MOTs, and the advice for cutting asthma attacks by using special mattress covers.
All these have certainly ruffled feathers, but what I’ve discovered about the damage caused by psychiatric drugs far outweighs anything else I’ve identified.
In fact, the data on all this is available if you know where to look, but I’m the first person to pull it all together – for instance, finding that the number of suicides among adults and children taking antidepressant drugs is actually 15 times greater than the number calculated by the U.S. drugs watchdog, the Food and Drug Administration.
Yet psychiatrists and GPs generally ignore or deny the appalling scale of this damage from drugs that are all too often used without medical justification.
Just this month, for instance, a study published in the BMJ found that thousands of people in England with learning difficulties are routinely prescribed antipsychotic drugs: these drugs do nothing to help these patients but are used as a chemical cosh.
I was alerted to the failings of psychiatric drugs eight years ago when one of my postgraduate students suggested an idea for her PhD thesis: ‘Why is history repeating itself? A study on benzodiazepines and antidepressants.’
She explained she’d discovered that popular tranquilisers such as Valium (a benzodiazepine drug more popularly known as ‘mother’s little helper’), and before that the barbiturates, had been described as very safe when first introduced, but then turned out to be highly addictive.
When selective serotonin reuptake inhibitors (antidepressants known as SSRIs) came on the market 20 years ago, their big selling point was that they were non-addictive. That proved just as wrong.
I decided to dig deeply into this area, and currently have three PhD students investigating what psychiatric drugs really do to people.
What we have found is truly astonishing. Doctors dispense them in large numbers because they believe drug trials show them to be effective, but the evidence is based on poor science.
The skeletons in this closet have been tumbling out at an alarming rate. Sleeping pills, for instance, stop being beneficial after a couple of weeks, yet patients are left on them for years, while antipsychotics are licensed if they show an effect in two placebo trials, no matter how small that effect is.
One reason why doctors have got it so wrong is a fatal flaw in the way the trials are done. No one is supposed to know which group is given the drug and which the placebo.
But in the trials it’s widely known who’s on a psychiatric drug because they cause definite side-effects such as nausea and dry mouth. The medics, whose account of how patients responded is used to judge how effective the treatment is, tend to report better results from the drug group, but these results are skewed by the fact that they knew the real drug had been given.
We know this happens because an analysis of trials by Cochrane Collaboration found that when the placebo was designed to cause similar side-effects to the drug, the psychiatrists reported just as good results from both groups.
In other words, the drug was found to be no more effective than the placebo.
1 IN 11
The proportion of adults thought to be taking an antidepressant
Claims by psychiatrists that the drugs do work have to be taken with a pinch of salt, not only because good evidence suggests they don’t, but also because those who run the trials almost always receive funding from drug companies.
Based on the same sort of flawed trials, antidepressants are also being handed out for conditions such as binge eating, panic disorder, obsessive compulsive disorder and menopausal symptoms.
The claimed benefits can be ludicrously small, for instance: they cut the rate of hot flushes from ten to nine a day.
Yet despite the lack of good evidence for their benefits, 57 million prescriptions for antidepressants are handed out a year in England alone – and patients are left on them for years.
One reason why drug use is steadily expanding is that there is no chemical marker to diagnose depression or anxiety. So everyday changes in mood, such as feeling less happy or more anxious, can be a reason for treatment.
Most of us could get one or more psychiatric diagnoses if we consulted a psychiatrist or GP.
A successful treatment for depression would allow people to lead more normal lives – go back to work, salvage relationships. But in all the thousands of trials, I’ve never seen evidence that antidepressants can do this.
Some patients may become a little euphoric or even manic on them, but in patient surveys many report feeling worse, saying the pills change their personality, and not in a good way; they may show less interest in other people and report feeling emotionally numb. ‘Like living under a cheese dish cover,’ is a typical description patients use.
Sexual function fades; libido drops in half of patients and half can’t orgasm or ejaculate. So antidepressants are not likely to save intimate relationships – they are more likely to destroy them.
When I gave a talk to Australian child psychiatrists, one of them said he knew three teenagers taking antidepressants who had attempted suicide because they couldn’t get an erection the first time they tried to have sex.
These boys didn’t know it was the pills – they thought there was something wrong with them. Although many psychiatrists still believe SSRIs cut the risk of suicide that can come with depression, it is well established that these drugs actually increase the risk in children and adolescents, and most likely in adults as well.
Despite the lack of a chemical marker for any psychiatric disorder, psychiatrists frequently claim the drugs work by correcting a chemical imbalance in the brain.
They say it’s like insulin and diabetes – patients can’t make enough serotonin. I’ve been told by a professor of psychiatry that stopping an antidepressant would be like taking insulin from a diabetic.
But it’s nonsense – no one has found that depressed people have less serotonin in their brains, for instance – in fact, some antidepressants actually lower serotonin.
This fairy tale has proved very damaging and can lead to patients becoming addicted. They are given more pills or a stronger dose in the hope that the ‘imbalance’ will be fixed, and can be on them for years.
When they try to come off the pills and experience very unpleasant side-effects, patients say they are told their symptoms are the result of their illness coming back.
This ignores the fact that the drugs’ withdrawal effects can mimic the symptoms of psychiatric disorders. It also doesn’t fit in with what happens when patients in desperation reach for the drugs again: within a few hours they can be feeling better. Real depression doesn’t fade that fast.
Doctors’ misconceptions about the drugs they prescribe are turning temporary problems into chronic ones.
More than one million people in the UK are addicted to sleeping pills and anti-anxiety drugs, according to the All Party Parliamentary Group on Involuntary Tranquiliser Addiction, even though for years official advice has been to not prescribe them for longer than four weeks.
Patient surveys reveal that similarly large numbers are having problems withdrawing from antidepressants. The case of Luke Montagu, told below, is a vivid and horrifying example of the destruction antidepressants and benzodiazepines can cause.
He still suffers from the crippling effects of withdrawal seven years after coming off the drugs, which he should never have been prescribed in the first place.
Yet the NHS does almost nothing to help these victims. There are disgracefully few facilities to treat them – fewer than ten in the whole country, and all these are run by small charities, some of which are closing due to lack of funding.
We need to educate doctors so they know how these drugs really work, and show them how to help patients stop taking the pills (by very gently reducing the dose).
According to my calculations, if psychiatric drugs were only prescribed for a few weeks in acute situations, we would only need 2 per cent of the prescriptions written at the moment for insomnia, depression and anxiety. The saving in human and financial terms would be enormous.
Later this week, I will be speaking at a major conference on how we can reduce the use of these drugs, More Harm than Good: Confronting The Psychiatric Medication Epidemic, which has been arranged by the Council for Evidence-based Psychiatry at the University of Roehampton in London.
My proposal is to start a campaign to Just Say No – it is time for a war on psychiatric drugs.
As told to JEROME BURNE
Peter Gøtzsche is a specialist in internal medicine and professor in clinical research design and analysis at the University of Copenhagen. His new book, Deadly Psychiatry And Organised Denial, is published by People’s Press. Visit deadlymedicines.dk. The Council for Evidence-based Psychiatry, cepuk.org.
FACT BOX TITLE
Luke Montagu, 45, pictured, is heir to the Earl of Sandwich and lives at Mapperton, in Dorset. Last year, the father-of-four founded the Council for Evidence-based Psychiatry to highlight the risks from psychiatric drugs. Here, he describes the devastating effect the pills have had on his life.
When I was 19 I had a sinus operation that left me with headaches and a sense of distance from the world.
I saw my GP after a few weeks, who told me what I now realise is a medical myth – that I had a chemical imbalance in my brain.
Luke Montagu, 45, pictured, is heir to the Earl of Sandwich and lives at Mapperton, in Dorset
The real problem was probably a reaction to the anaesthetic, which might have improved itself if left. But I was prescribed various antidepressants including Prozac. These didn’t help so I saw other doctors and psychiatrists, but no one really listened when I suggested it had begun with the operation.
All offered different diagnoses and all gave me drugs. I was prescribed nine different pills in four years.
Although the drugs never made me feel better for long, I reluctantly concluded that I did have something wrong with me – I’d tried to come off the drugs a couple of times but felt so awful that I went back to them.
I thought I needed the medication, but in fact I was going into withdrawal each time. In 1995, I was given the antidepressant Seroxat and took it for seven years.
When I tried to come off it I felt dizzy and couldn’t sleep. I was also in a state of extreme anxiety. These were withdrawal symptoms, but, thinking I was seriously ill, I saw a psychiatrist.
He gave me four new drugs, including the sleeping pill clonazepam. I quickly felt better, not realising I’d become as dependent as a junkie on heroin.
I functioned OK for a few years, but gradually became more and more tired and forgetful. So, in 2009, believing it was due to the drugs, I booked into an addiction clinic.
My psychiatrist advised me to come off the clonazepam right away and within three days I was hit by a tsunami of horrific symptoms – my brain felt like it had been torn in two, there was a high-pitched ringing in my ears and I couldn’t think.
I now know this was terrible advice: rapid withdrawal from long-term use of sleeping pills is nearly always a disaster. The detox was the start of nearly seven years of hell. It was as if parts of my brain had been erased.
About three years ago, I very slowly began to recover. I still have a burning pins and needles sensation throughout my body, loud tinnitus and a feeling of intense agitation.
Debatindlæg i Politiken 3. sept. 2015 af Peter C Gøtzsche
Professor Poul Videbech mener, at jeg ”imod bedre vidende” skyder min modstander ufine motiver i skoen (30. august). Han nævner, at man i 20 år har kendt til, at teorien om den kemiske ubalance i hjernen ved depression er alt for simpel, og at det derfor er ”ude i hampen”, når han selv og andre tillægges den slags synspunkter.
Det er Videbech, ikke jeg, der taler imod bedre vidende. I en undersøgelse danske psykiatere publicerede i 2005 , siger 80% af patienterne, at ”antidepressiva korrigerer de forandringer, som var i min hjerne”. Hvor mon de har den viden fra? Mange er også blevet fortalt, at de vil få medicin, der retter op på ubalancen, ganske som insulin virker på sukkersyge. Videbech benytter sig også af denne totalt misvisende sammenligning. På et møde i Aarhus den 11. september sidste år argumenterede jeg for, at vi skulle nedbringe forbruget af antidepressiva, men Videbech svarede foran 600 mennesker: “Hvem ville tage insulin fra en diabetiker?”
Videbech hævder, at effekten af psykoterapi sætter langsommere ind end andre behandlinger. Det er heller ikke rigtigt. Antidepressiva virker jo slet ikke på depression, når man spørger de patienter, der har deltaget i lodtrækningsforsøg, hvor halvdelen har fået placebo.
Professor Birthe Glenthøj nævnte også den ikke-eksisterende kemiske ubalance. Hun sagde, at forskningen viser, at patienter, der lider af skizofreni, har for meget dopamin i deres hjerne. Der findes ingen pålidelig forskning, der har påvist forskelle mellem patienter med skizofreni og raske personer. Det passer heller ikke, at antipsykotika hjælper de fleste patienter med alvorlige psykoser. Virkningen af de nyere antipsykotika er så ringe, at den er mindre end den mindste fremgang, der betyder noget for patienterne, dvs. de virker faktisk ikke, og skadevirkningerne er langt større end denne tvivlsomme effekt. Det er heller ikke rigtigt, at det var pga. antipsykotika, at patienter med skizofreni kom ud af institutionerne. Udslusningen af patienterne skyldtes økonomiske overvejelser og faldt ikke tidsmæssigt sammen med, at man begyndte at bruge antipsykotika.
Psykiatriprofessor Raben Rosenberg forestiller sig (1. september), at jeg skaber min egen virkelighed om psykiatrien, og at jeg fører an i et uetisk, monomant antipsykiatrisk korstog med ekstreme standpunkter, som er en hetz mod psykisk syge, der skaber utryghed og krænker dem. Jeg siges også at udvælge og tolke den videnskabelige litteratur, som det passer mig og kritiseres for at påpege, at psykoterapi burde være hovedbehandlingen af psykiske lidelser. Politiken får også et gevaldigt drag over nakken for at ”puste kraftigt til den antipsykiatriske ild”. Rosenberg glæder sig samtidig over den ”massive bedring”, man kan opnå gennem medicinsk behandling.
Rosenberg har ingen argumenter, men fører sig frem med svulstig retorik og personangreb. Den påståede ”massive bedring” på psykofarmaka eksisterer kun i psykiaternes fantasi, ikke i virkeligheden. I lodtrækningsforsøgene har patienterne som nævnt sagt, at antidepressiva ikke virker; det er kun psykiaterne, der siger, at de virker. Og virkningen af de nyere antipsykotika er som nævnt også tvivlsom. ADHD-medicin har måske en forbigående effekt, men allerede efter et par år er den væk, og medicinen er skadelig på langt sigt. Forskningen viser i øvrigt, at formentlig alle psykofarmaka kan forårsage kroniske hjerneskader og medicinafhængighed. Derudover slår psykofarmaka så mange ihjel, at jeg har estimeret, at de er den tredjestørste dødsårsag, efter hjerte-kar-sygdomme og kræft. Det kan en tvivlsom effekt ikke berettige.
Der er i det hele taget en kolossal modsætning mellem, hvad psykiaterne mener om psykofarmaka, og hvad patienterne og befolkningen mener om dem. I en stor undersøgelse af 2.031 personer fra 1995 syntes de adspurgte generelt, at antidepressiva, antipsykotika og indlæggelse på en psykiatrisk afdeling oftere var skadelig end gavnlig. De konklusioner er jeg også nået frem til efter at have studeret forskningslitteraturen grundigt, og jeg har konstateret, at psykoterapi har bedre langtidseffekter end medicin, hvilket er påvist i lodtrækningsforsøg, der som bekendt er den mest pålidelige type forskning, vi har. Psykoterapi virker også på skizofreni.
Prioriteringen i psykiatrien med dens kolossale overforbrug af medicin er derfor helt gal. Den skader patienterne langt mere end den gavner. Det er i øvrigt heller ikke sygdommen, der giver varige hjerneskader, hvilket flere danske psykiatriprofessorer hævder. Det er medicinen.
Alt dette dokumenterer jeg i min bog. Den er i allerhøjeste grad evidensbaseret og henviser hele tiden til den bedste forskning, jeg har kunnet finde. Det er trist, at førende psykiatere fortsat holder fast i en række myter, der er skadelige for patienterne. Videbech fejlinformerer ovenikøbet læserne om, hvad han selv mener. For yderligere oplysninger, se www.deadlymedicines.dk