As I write about on my website, I am an outraged psychologist.
I am outraged at witnessing people harmed by the current mental health system, which stigmatizes them as “diseased,” which leads to hopelessness and self-judgment about normal emotional responses. It falsely claims that chemical imbalances and genetic conditions cause mental illness, then pushes harmful psychiatric drugs as the primary solution. It completely ignores fundamental facts about us as humans — that our environment and life experiences are very impactful on our emotional wellbeing. As social animals, our relationships are very influential, especially if they make us fee unworthy, rejected or excluded, (often because of experiences with emotionally neglectful or abusive parents in childhood). And that if we struggle to feel accepted and worthy as children, we are going to struggle to give ourself self-compassion as adults.
I regularly hear from clients who are prescribed psychiatric medications for their “ADHD” or “depression,” yet they have no clear understanding of the facts about these diagnostic labels or the effects of the drugs. I hope this fact sheet provides patients, mental health clinicians and primary care providers with clear, accessible and thorough information. I have provided footnotes to studies mentioned. The resource section on the last page lists websites and books about these concepts.
“Mental disorders” are NOT caused by genetics or chemical imbalances.
- There is NO scientific evidence that “mental disorders” are caused by chemical imbalances in the brain or by genetic disorders. Depression is not caused by low serotonin and schizophrenia is not caused by an excess of dopamine. The reality is that “[c]ontemporary neuroscience research has failed to confirm any serotonergic lesion in any mental disorder, and has in fact provided significant counterevidence to the explanation of a simple neurotransmitter deficiency.”
- A July 2022 article in the journal Molecular Psychiatry examined hundreds of studies and concluded there was no evidence of a link between depression and serotonin.[1a]
- In August 2022 in the journal Neuron, Raymond Dolan, considered one of the most influential neuroscientists in the world, co-authored “Function Neuroimaging in Psychiatry and the Case for Failing Better.” Reflecting on the more than 16,000 neuroimaging articles published in the last 30 years, they concluded, “Despite three decades of intense neuroimaging research, we still lack a neurobiological account for any psychiatric condition.” [1b]
- A meta-analysis of 107,000 studies failed to find a biological marker for any mental illness.
- This web article by a neuroscientist summarized a number of studies looking for genetic and neurobiological causes of depression and concluded: “Thus, neither the neuroimaging nor genetic associations came anywhere near to localizing a depression-related disturbance in an individual brain, nor even distinguishing a group of depressed brains from a group of healthy ones.”
- Despite a lack of objective evidence, psychiatrists and Big Pharma have claimed for decades that people diagnosed “mentally ill” have a “chemical imbalance.” Scientists knew in the 1970s that this was not true, but psychiatry betrayed the public by repeating this false narrative. Many pharmaceutical and mental health websites continue to allude to people needing drugs to correct a chemical imbalance, despite this being completely false.
- Phillip Hickey, PhD, a leading anti-psychiatry advocate, calls it “the Great Psychiatric Hoax: that all significant problems of thinking, feeling, and behaving, including childhood distractibility, are illnesses, requiring expert medical intervention and drugs. And this perverse notion — that all significant problems of thinking, feeling, and behaving are biological illnesses — is the cornerstone of all pharma-psychiatric marketing: you need our products because your brain is sick; your child needs our products because his/her brain is sick; your aging parents need our products because their brains are sick; etc…. [T]he fundamental flaw – the great lie – is that all significant problems of thinking, feeling, and behaving are illnesses. This is the very basis of psychiatry – the fundamental justification for medical intervention. And it is a lie. And it is irremediable.”
- “Mental disorders” are really problems in functioning regarding emotional, behavioral, characterological, moral and social/interpersonal arenas, most often driven by poor shame tolerance.
- This article summarizes the history of research looking to find a genetic cause of depression. There has been a “failure of family studies, twin studies, adoption studies, linkage studies, candidate gene studies, and rare variant studies to produce scientifically acceptable evidence that disordered genes play a role in causing” major depression. A 2019 analysis in the American Journal of Psychiatry concluded that “[T]he results suggest that early hypotheses about depression candidate genes were incorrect and that the large number of associations reported in the depression candidate gene literate are likely to be false positives.” 
There is a tremendous amount of scientific evidence that “mental disorders” ARE caused by emotional distress, usually resulting from:
- chronic developmental or attachment trauma (emotionally dysfunctional parents, chaotic home life, narcissistic parents or siblings, substance abusing parents, etc.)
- acute traumas (sexual or physical abuse, victim of crime, etc) 
- social/cultural adversities (poverty, racial discrimination, gender or sexual identity discrimination, immigrant status, homelessness, high crime neighborhoods, involvement in child welfare system, etc).
- low self-worth and poor shame tolerance, resulting in high levels of guilt (Self-Blaming), low levels of guilt/shame (Other-Blaming) and Blame Avoidance.
Psychiatric Drugs are Not Improving Mental Health
- Psychiatry’s treatment outcomes are abysmal. In 2021, the New York Times concluded that psychiatry had done “little to improve the lives of the millions of people living with persistent mental distress. Almost every measure of our collective mental health—rates of suicide, anxiety, depression, addiction deaths, psychiatric prescription use—went the wrong direction, even as access to services expanded greatly.”
- Thomas Insel, former director of the National Institutes of Mental Health (NIMH) in a 2022 article in Healing repeated to the general public what he had previously acknowledged about psychiatry’s history of abysmal outcomes, noting: “While we studied the risk factors for suicide, the death rate had climbed 33 percent” despite increased treatment. He also stated: “Since 2001, prescriptions for psychiatric medications have more than doubled, with one in six American adults on a psychiatric drug.”
- Antidepressants don’t work very well…which makes one wonder why they are prescribed. Rush et all (2006) found that over 50% of patients diagnosed with depression do not remit after first-line antidepressant medication, and approximately 30% may not remit after multiple treatments. [5a]
Problems with Prescribing and Prescribers
- Psychiatrists and PCPs routinely prescribe psychiatric medications without first having the patient try psychotherapy — the least harmful, most effective first-line intervention. Children are given drugs without PCPs advocating for parenting education or family therapy. Rather than merely throw drugs at emotional responses, wouldn’t the conservative response be to try the least-invasive treatment possible before prescribing brain-damaging drugs?
- Psychiatrists and PCPs often prescribe after only a 10-15 minute verbal evaluation of the client, based only on the client’s reported “symptoms.” Many clients read lists of symptoms on the internet and know what to report to get a diagnosis and be prescribed drugs.
- Most PCPs and psychiatrists don’t see the negative effects of the drugs in patients they prescribe to. If the patient has negative effects, they stop taking the drugs and don’t go back for refills. If the patient has no decrease in “depression symptoms,” they, too, may stop taking the drugs without informing the doctor. So the doctor never gets any anecdotal feedback that the drugs are harmful or not helpful. On the other hand, they only see the patients who feel they have been helped by the drugs, as these people keep taking them and return for refills. This blinds the local doctor to the placebo effect and the harmful adverse effects that are proven in scientific studies. They only see the positive results of prescribing. Of course, even this positive effect may be more about placebo responding and the natural tendency of “depression” and other moods to be transient.
- Psychiatrists and PCPs rarely engage in informed consent with patients prior to prescribing. I have yet to talk to a patient who was told by a PCP or psychiatrist about a drug’s adverse effects, plan for length of treatment, and plan for withdrawal. (See “Informed Consent” and “How to Talk to Your Doctor” below.)
- Very few psychiatrists or PCPs understand how and when to withdraw patients from drugs. They often fail to make a plan to withdraw the drugs or educate patients on how this process will work and the harmful effects that can occur. Patients then do not understand they will have harmful withdrawal effects if they quit the drugs abruptly and may assume that these effects are “my depression returning.” (See these resources for information on how to withdraw from psychiatric drugs and below in Resources.)
- Most psychiatric drugs aren’t actually prescribed by psychiatrists. Mark and colleagues found that from August 2006 to July 2007, 59 percent of US prescriptions for psychiatric drugs were written by general practitioners, 19 percent by other physicians and non-physician providers, and just 23 percent by psychiatrists.
- The vast majority of people are being prescribed “antidepressants” without receiving any psychiatric diagnoses. A 2011 study found that “between 1996 and 2007, the proportion of visits at which antidepressants were prescribed but no psychiatric diagnoses were noted increased from 59.5 percent to 72.7 percent.”
- Multiple drugs are often given at the same time for conflicting reasons, such as teens given “ADHD” drugs and “anti-depressants.” Stimulants are often given to “treat anxiety,” which is completely counter-intuitive as they increase anxiety.
- Children and adults are often started on antidepressants in the hospital after a suicide threat or attempt, yet these drugs take 4-6 weeks have any effect, if they are going to work. Why not try psychotherapy first, rather than immediately prescribe harmful drugs?
- I often hear after the fact from a patient that their PCP diagnosed them without consulting with me and the PCP’s diagnosis was completely different from mine — indicative of poor coordination of care and the poor reliability of the DSM.
- Big Pharma has 2 lobbyists for every member of Congress.
Diagnostic Labels Are Harmful, Stigmatizing, Invalid and Unscientific.
- The current mental health diagnostic system has for decades hindered therapeutic treatment and caused harm by complicating what are very simple, understandable concepts that underlie human behavior. It misleads and confuses the public and mental health clinicians.
- Psychiatric diagnoses are ambiguous and subjective. The diagnostic criteria and labels used in the Diagnostic and Statistical Manual (DSM-5) that establishes the “mental disorders”, such as Major Depressive Disorder and Bi-Polar Disorder, are arbitrarily decided by a vote in a committee. While these labels may be a helpful for researchers and clinicians as a shorthand to categorize behaviors, the labels are not based on any scientific understanding of these being discrete, measurable biological diseases. Dr. Hickey, in an article on over-diagnosis of ADHD, states: “(T)hose of us on the anti-psychiatry side of the issue have been saying for years that the various items listed in the DSM are nothing more than loose collections of vaguely defined problems with no explanatory or ontological significance.”
- 68% of the DSM-5 committee members had ties to pharmaceutical companies and have a vested interest in continuing the false paradigm of the “medical model” of mental illness. 
- DSM diagnostic labels are based merely on a checklist of symptoms and offer no proof of causes of these behaviors. DSM diagnoses are merely descriptions and tautologies, in other words something that is a circular or redundant description without causation. For example, a tautology is like a doctor saying: “The pain in your head is caused by a headache.” An actual diagnosis is: “The pain in your head is caused by a stroke.” So an ADHD “diagnosis,” for example, is merely a description of behaviors: hyperactivity, impulsivity, distractibility. There is no cause identified.
- The DSM provides no framework for understanding the cause of distress and provides no intervention recommendations. The DSM offers no logical connection between assessment, “diagnosis,” case formulation, and “treatment.” This would be like a medical doctor saying “We believe you have diabetes, but we don’t know what causes diabetes, and we don’t know the best treatment for diabetes, but here are some drugs — and we don’t actually know how these drugs work.”
- Labels stigmatize clients as “permanently disordered”, leading to feelings of shame, which drives clients away from seeking treatment, increases emotional distress, and worsens outcomes.
- While establishment psychiatry rails against the stigma of mental illness, they have actually exacerbated it through their “brain disease” explanations. A 2010 study in Psychiatry Research reported that for the general public, the acceptance of the brain disease or “biogenetic model” of mental illness was associated with a desire for a greater social distance from the “mentally ill.” A review of 33 studies drew similar conclusions, reporting that biological conceptions of “mental illness” do not reduce stigma and can actually exacerbate stigmatizing attitudes.
- The DSM labels promote helplessness and lack of accountability for personal change because people are told they have a lifelong and untreatable mental disorder.
- The DSM leads clinicians to view clients as “diseased” and “disordered,” which shuts down acceptance, hope, and empathy. “Indeed, we find that biological explanations significantly reduce clinicians’ empathy. This is alarming because clinicians’ empathy is important for the therapeutic alliance between mental health providers and patients and significantly predicts positive clinical outcomes.” 
- The DSM promotes ineffective and harmful drugs over effective and harmless therapy or self-help.
- The DSM wastes money on ineffective treatment and pointless research.
- The DSM completely ignores the real cause of suffering, such as environmental trauma, relationship or attachment trauma, parental abuse or neglect, unhealthy relationships, social/cultural impacts, or negative self-image.
- The DSM criteria say that if a person is grieving after the death of a child, for example, for more than two weeks, then this is diagnosable as Major Depressive Disorder.
- Kenneth Kendler, an extremely prolific researcher with more than 1,200 papers, and a member of the committees writing the DSM-II, DSM-IV, and DSM-5, wrote a piece in JAMA Psychiatry that there is little scientific evidence for psychiatric diagnoses and that he believes the DSM diagnoses do not “correspond to reality” and it is “implausible” that they are “approximately true.” [See article: https://www.madinamerica.com/2021/12/kenneth-kendler-implausible-psychiatric-diagnoses-even-approximately-true/]
- The DSM completely ignores the impact of emotionally abusive or coercive relationships with people who could be labeled sociopathic, narcissistic and toxic, yet these types of individuals cause untold psychological harm to millions of children and adults.
- Typical human experiences — such as fear, shame, loneliness, self-criticism, and the need for love and belonging — are being labeled as mental disorders. Shame is called “the master emotion” because it is considered the cause of nearly all emotional distress, yet the DSM never once mentions shame as a trans-diagnostic cause of emotional distress.
- The DSM ignores well-accepted concepts that explain feelings of unworthiness and shame, including the neurobiology of fear (“fight-or-flight”), the natural human craving for social acceptance and bonding, and the harms of trauma and unhealthy parenting.
- It is less stigmatizing to reframe emotional and behavioral problems as adaptive and self-protective responses to trauma, fear, shame, feelings of rejection, and inadequate parental bonding.
Psychoactive drugs often make mental health and functioning worse
- Let’s start with the fact that psychiatric drugs are actually synthetic, artificial chemical compounds that are made in large chemical factories. Why is it hard to believe they might be neurotoxins?
- As noted by many authors, including Robert Whitaker in “Anatomy of an Epidemic” and “Mad In America,” there is conclusive evidence that all classes of psychiatric drugs produce chronic brain impairment, frequently prevent recovery, impair functioning, and can cause chronic or permanent disability.
- Psychiatric medications have serious adverse effects that actually are worse than the original, presenting complaint, and may damage longterm health.
- Psychiatric drugs do NOT fix or cure “pathology” or “disease,” because there is no disease to cure.
- Psychiatric drugs actually DO create abnormalities in neurotransmitter function and “changes in neural function that are produced as adaptations to chronic administration of addictive drugs such as psychostimulants and therapeutic drugs such as antidepressants,”according to a 1996 paper by then National Institute of Mental Health (NIMH) director Stephen Hyman. It provided a good description of how psychiatric medications actually “work”: The drugs are better understood as agents that create abnormalities in brain function. (See “How Anti-Depressants Work” toward the end of this fact sheet.)
- Psychiatrist Peter Breggin, MD, has been called “The Conscience of Psychiatry” for his decades of successful efforts to reform the field. He lists the “three most important things for anyone to know about psychiatric drugs”:
- Psychiatric drugs are neurotoxins. They poison the brain, injuring brain cells and causing severe biochemical imbalances and potential biological chaos. Because drug companies design them to cross the blood brain barrier and to impair specific neurotransmitter systems, every psychiatric drug is a potent neurotoxin. They cannot “fix” biochemical imbalances because there are no biochemical imbalances in the brains of troubled, suffering people; and more specifically because they are tailored in the lab to disrupt brain function and not to fix it. As neurotoxins, they are bad for the brain with the first dose. They can cause tragic harm, such as suicide and violence early in treatment, and tend to cause brain damage and apathy after longer exposure.
- Psychiatric drugs “work” by harming your brain and mind (the brain-disabling principle). Like any form of brain injury, some psychiatric drugs can cause temporary highs; but all cause emotional blunting and loss of touch with oneself and others. They make people care less about their own lives and the lives others. They cause these effects by infiltrating the entire brain, diminishing the overall function, including in the super-sensitive basal ganglia, limbic system, temporal lobe and frontal lobe.
- Psychiatric drugs will hide their harmful effects from you, just as most people who use alcohol, marijuana, cocaine or narcotics are the last to know how much they are being harmed or harming others while “under the influence.” Some people insist these neurotoxins are helpful when the main long-term effect consists of diminished awareness, sensitivity or feeling. The same is especially true of psychiatric drugs, because drug companies tailor them to target and disrupt major neurotransmitter systems like dopamine and serotonin. People taking psychiatric drugs often underestimate the harm and overestimate any good effects. This is “medication spellbinding.”
- ADHD medications have been shown to be effective in reducing core ADHD symptoms, such as task irrelevant activity (e.g. finger-tapping, fidgetiness, and and off-task behaviors), and classroom disturbance.  However, the drugs have not been shown to improve classroom performance, and long-term use of ADHD medication is associated with worse outcomes in multiple domains, including academic achievement. The medications may cause a wide range of physical, emotional, and cognitive adverse effects.
- The long-term effects of ADHD drugs on the brain are not well understood, or even well studied. However, in 2016, researchers reported that after four months of exposure to an ADHD drug, there is evidence of brain changes in children that may be long-lasting, and even permanent.
- Various adverse effects to ADHD drugs also increase the risk that a medicated youth will turn “bipolar.” In one study at Massachusetts General Hospital, researchers reported that 11% of children diagnosed with ADHD and treated with stimulants developed bipolar symptoms, which were not present at initial diagnosis, within four years.
- Researchers at the University of Cincinnati Medical Center determined that two-thirds of the adolescent patients hospitalized for mania at their center had been on stimulants “prior to the onset of an affective episode.” Stimulants, they concluded, may “precipitate depression and/or mania in children who would not have otherwise developed bipolar disorder.” [19[
- This web page lists numerous studies showing negative impacts of ADHD meds and many resources on treatment guidelines.
Antidepressant Adverse Effects
- “Antidepressants” have a plethora of harmful effects, including sexual dysfunction,  brain abnormalities, suicide,  violence, mortality,  and risks during pregnancy.
- “Why should drugs, named for their supposed specificity, as in selective serotonin reuptake inhibitor (SSRI), cause such diverse effects? Because when the drugs inhibit reuptake of serotonin into synapses, that is just the start [25a-c]. They also inhibit reuptake of other neurotransmitters, though less strongly, such as norepinephrine, dopamine, and histamine. The SSRIs antagonize the neurotransmitter acetylcholine at its M1 receptor, inhibit synthesis of the neurotransmitter nitric oxide [25d], increase potency of endogenous opioids at delta opioid receptor [25e], and allosterically sensitize the receptor for the neuromodulator, brain-derived growth factor (BDNF) [25f]. In short, SSRIs are not specific but rather affect at least eight distinct neurotransmitter/neuromodulator systems distributed throughout the body and brain. Consequently, the drugs perturb such diverse processes as blood clotting, carbohydrate metabolism, inflammatory response, cognition, learning, and memory.” [25 g, Excerpted from here.]
- Human studies show that SSRI use during pregnancy is associated with miscarriage, birth defects, preterm birth, preeclampsia, decreased fetal head size, newborn behavioral syndrome, seizures, neonatal EKG changes, childhood brain malformations, and long-term neurobehavioral issues like ADHD and autism. See this article for many links to scientific studies.
- Several recent studies have shown that males who take SSRI antidepressants will have reduced sperm concentration, more sperm with DNA fragmentation, and more abnormal sperm.
- Antidepressants harm sexual function in adults causing erectile dysfunction, anorgasmia and decreased libido. These effects can persist even after stopping antidepressants and may be permanent in some people, as now recognized by the European Medicines Agency.
- In patients diagnosed with unipolar depression, treatment with antidepressants more than triples the risk that they will convert to bipolar illness, such that 20% to 40% of long-term users of antidepressants today end up with bipolar diagnosis. In a survey of members of the Depressive and Manic-Depressive Association, 60% of those with a bipolar diagnosis reported that they had “turned bipolar” after exposure to an antidepressant. 
- Very few long-term studies of drug effects have been performed, so the drugs’ effects on developing infants, children, and adolescents tend to be largely unknown.
- Depression pills and major tranquilizers (antipsychotics/neuroleptics) can create psychosis and hallucinations, two of the positive symptoms of “schizophrenia,” via anticholinergic toxidrome poisoning.
- Depression pills significantly increase the risk of suicide because they cause akathisia, an inner restlessness. Antidepressants cause an activation syndrome in 11-14% of young people consisting of “irritability, agitation, impulsivity, emotional lability, hostility, restlessness and aggression.” Many people assume they are “going crazy” and there is no relief, so death seems reasonable.
- In 2008, FDA issued a black box warning about a link between suicidal thoughts and the SSRIs.
- Glaxo issued a statement warning doctors that there was a six-fold increase in suicidal behavior in young adults taking Paxil.
- Depression pills cause emotional blunting, so that people care less about themselves or others, leading to worsening problems with low motivation, low mood, and low self-worth, which are the markers for “depression”.
- There are no long-term studies done on the effect of antidepressants on “brain development, physical growth and sexual function and fertility.” Most drug studies last only 6-12 weeks.
Benzos, Stimulants & Drug Cocktails
- If Adderall and Ritalin decrease growth in children by an average of 2 inches then what do they do to the brain?
- Benzodiazepines (Xanax, Valium, Klonopin, etc) are highly addictive and have been completely banned in Europe.
- Essentially no studies have been done on “cocktails” of psychiatric drugs to understand the interactions between two drugs or more. You are, in essence, being used as a guinea pig if you take multiple drugs and the effects will not be known for years.
- The major tranquilizers (benzos) can also create the negative symptoms of “schizophrenia,” via neuroleptic induced deficit syndrome.
- Benzodiazapines are linked to deficits in social cognition, “the mental processes that underlie the ability to understand and act on the thought, intentions, and behaviors of others,” according to a review of 40 research papers. 
- Martin Harrow and Thomas Jobe began a study, funded by the National Institute of Mental Health, in the late 1970s about the long-term effects of antipsychotics and other psychiatric drugs. In 2007, they reported that the long-term recovery rate for schizophrenia patients off antipsychotic medication was eight times higher than for those on the medication (40% versus 5%). Antipsychotics induce a dopamine super-sensitivity that made patients more biologically vulnerable to psychosis than they otherwise would be in the natural course of the illness. Antipsychotics may worsen those symptoms over the long term and worsen the long-term course of schizophrenia and other psychotic disorders.
Psychiatric Drugs Are Not Effective
- The Mad In America website has an excellent summary of the research on SSRI effectiveness, including this statement: “The scientific literature tells a story that stretches over the span of fifty years. When the antidepressants are introduced, at least a few psychiatrists worry that the drug treatment is causing a chronification of the disorder. Over the next two decades, researchers find that patients treated with antidepressants are relapsing more frequently than before. Studies in the 1990s and early 2000s do indeed find that the majority of depressed patients do not achieve a sustained recovery. Medicated depression is found to run a more chronic course than it had in the pre-antidepressant era. Numerous studies since 1995 tell of how patients treated with antidepressants are more likely than unmedicated patients to remain symptomatic over longer periods of time. Studies find that antidepressants increase the risk that a person suffering from an episode of depression will become disabled by the disorder. In country after country, the increased prescribing of antidepressants has been accompanied by an increase in disability due to mood disorders.”
- In a large NIMH trial of 4,041 “real-world” outpatients, known as the STAR*D study, only 108 patients given antidepressants stayed well and in the trial during the one-year followup, a stay-well rate of 3%.
- In an 18-month NIMH study that compared four types of treatment (two forms of psychotherapy, an antidepressant, and placebo), the group that was initially treated with the antidepressant had the lowest stay-well rate by the end of the study.
- In 2002, Irving Kirsch and colleagues at the University of Connecticut, using the Freedom of Information Act, gained access to all clinical trials of antidepressants submitted to the Food and Drug Administration (FDA) by the pharmaceutical companies as part of the medication approval process. When the published and unpublished trials were pooled, they showed that most of the “effectiveness” of antidepressants is caused by the placebo effect —people believing they are taking a pill that will help make their depression “better.”
- They reported that the difference in symptom reduction between the medicated and placebo groups was less than two points on the Hamilton Rating Scale of Depression (HAM-D). The National Institute of Clinical Excellence in the UK has stated that there needs to be at least a 3-point difference on this scale to be clinically relevant, and Kirsch found that it was only in a subset of patients, those severely depressed, that SSRIs met this standard. Kirsch and others have calculated “effect sizes” of around 0.30 for antidepressants based on symptom scores. This means that there is an 88% overlap in the distribution of outcomes for the drug-treated and placebo patients. Thus, the risk benefit equation from this symptom-reduction data can be summed up in this manner: Is exposure to the adverse effects of drug treatment worth the 12% chance of a better outcome? Or to put it another way: 12% of patients will benefit from the treatment, while the remaining 88% will suffer the adverse effects of treatment without any additional therapeutic benefit beyond placebo. Those are the odds that a person contemplating taking an antidepressant drug might want to know.
- The placebo response was 82% of the antidepressant response—in Prozac’s case it was 89%. The studies fail to show a clinically significant advantage for antidepressant medication over inert placebo. In other words, for every ten people who take an SSRI, only one or two people are truly receiving a benefit from the medication—a fact acknowledged even by the SSRI proponents. The obvious question is: What about the eight or nine people getting no benefits from the medication but now put at risk for the medication’s side effects? 
- Kirsch replicated the meta-analysis in 2008 and found the same results. 
- Three other studies replicated Kirsch’s findings.   
Escalation of Drug Prescribing and Diagnosis
- In July of 2007, a government study found that antidepressants are the most prescribed drugs in the US. From 2002 to 2008 patients spent $123 billion on psychotropic drugs. In 2005, doctors wrote 31 million prescriptions for antidepressants. in 2004, the pharmaceutical companies spent $1.5 billion promoting antidepressants.
- About one in six Americans take a psychiatric drug and about one in eight take an anti-depressant.
- In the United States, the diagnosis of depression doubled between 1991 and 2000, coinciding with the introduction of the SSRI medications. These medications were not marketed by explaining the problematic correlational data; instead, they were sold as remedying the supposed chemical imbalance that caused depression.
Problems with Research
Much has been written about the flaws and corruption involved in research on psychiatric drugs.
Robert Whitaker’s Mad in America website offers numerous articles, including this comprehensive piece on the problems with “Randomized Controlled Trials (RCTs) in psychiatry: Our RCT Fetish: How the “Gold Standard” for Research Has Led to A Societal Delusion About the Merits of Antidepressants
- Keep an open mind. Question the sources of information you read or myths you have adopted as truth. Big Pharma and psychiatrists have a multi-billion dollar financial incentive to get you to believe you need their drugs for life.
- Give psychotherapy and self-help solutions, such as meditation and self-care, an honest try before you resort to taking a prescription.
- Know that your emotions will pass and you may likely feel better without doing anything. In an NIMH study of “untreated depression,” 23% of the non-medicated patients recovered in one month; 67% in six months; and 85% within a year. “If as many as 85% of depressed individuals who go without treatments spontaneously recover within one year, it would be extremely difficult for any intervention to demonstrate a superior result to this,” the investigators wrote.
- Be aware of the expertise, training and biases of the person you are consulting for your emotional struggles. Psychiatrists are medical doctors (M.D.) trained ONLY to prescribe pills as a solution to emotional problems. They are NOT trained in providing psychotherapy and very few offer this service. You may also be prescribed pills by your primary care physician (PCP) or a licensed professional nurse (LPN). They have no training in psychotherapy and may not have training understanding trauma, attachment patterns or other causes of emotional issues.
- Other mental health professionals usually DO have training in non-pill ways of handling emotional struggles. They have many titles: Psychologists, social workers, counselors, and marriage and family therapists.
- Consider alternative case formulations of mental health, such as the concepts in my Self-Acceptance Psychology, as exemplified in this case study. Consider “non-biological” causes of distress, such as this psychiatrist describes.
- Compassion-Focused Therapy and Mindful Self-Compassion are evidence-based interventions that DO provide long-lasting recovery from psychological distress in weeks or months with no harmful side effects. For a list of research titles: https://self-compassion.org/the-research/ For information on self-compassion concepts read this blog.
- Explanations that are environmental—you feel distressed because of something that happened to you—and normalize distress as a natural reaction lead to less stigma and discrimination.
- Be sure to ask questions of your doctor before taking drugs. (See “Informed Consent” and “How to Talk to Your Doctor” below.)
- Most doctors do not provide complete informed consent to patients, especially when prescribing to children. This practice is extremely unethical and runs counter to standard practice throughout the rest of medicine and research.
- If a child or adult has a negative reaction to a drug, doctors often assume this is a worsening of the original “mental disorder.” Rather than withdrawing or reducing the dosage, they often increase the dosage or add another drug or add a diagnosis.
How to Talk to Your Prescriber
If you are still interested in being prescribed medications, please consider getting fully informed consent. Informed consent means if you are being given drugs you should know the reasons it is being prescribed, your diagnosis, common and potential adverse affects, drug interactions, risk of dependency and addiction, and contra-indications with other substances, health conditions or health concerns. You should also be offered other options to taking the drug, such as psychotherapy.
Ask your prescriber these questions:
- What is my diagnosis? What are you basing my diagnosis on? Did you conduct a standardized assessment? Can I see and understand the results?
- How are you deciding to prescribe THIS medication versus another?
- Is this drug FDA approved for me or my child for the diagnosis you have given me/my child?
- What other non-drug options do I have (psychotherapy, self-help, self-care, improved exercise/sleep/nutrition, reducing caffeine use, eliminating alcohol and marijuana/recreational drugs, etc)
- Why is medication preferred over these non-drug options, especially psychotherapy?
- If I am already seeing a psychotherapist, have you talked to my psychotherapist about my diagnosis or condition and about your recommendation to prescribe drugs?
- What are the specific short-term and long-term adverse effects and benefits of this drug?
- How will you and I monitor adverse effects?
- What is your plan if I report these harmful effects? Will you increase or decrease the medication? Will you add a medication? Which medication? Why?
- How long should I plan to be on the medication? Why?
- What is the plan at outset for withdrawing?
- What experience do you have working with withdrawal?
- What symptoms should I expect when I withdraw?
- Will you prescribe reduced dosing or taper strips for withdrawal?
- How often will this medication be reviewed and how will we determine I should stop it? What assessments will you conduct? How will I know it is time to stop the medication?
- What is your plan if this medication does not work as you expect? Will you change medications? Add medications? Will you help me taper between drugs if you decide to do these things?
How Do Anti-Depressants Work in the Brain?
The major anti-depressants today are called Selective Serotonin Re-uptake Inhibitors (SSRI) or Selective Norepinephrine Re-uptake Inhibitors (SNRI) and these names help us understand how they impact the brain. SSRIs stop the re-uptake of serotonin and SNRIs stop the re-uptake of both serotonin and norepinephrine.
Serotonin and norepinephrine are neurotransmitters, brain messenger chemicals that carry signals between nerve cells in the brain. They are thought to be involved in regulating many functions, influencing emotions, mood, memory and sleep.
The brain is made up of millions of interconnected brain cells call neurons. Messages travel along these cells like electricity down a wire, but when the message reaches the end of the neuron, it has to jump the gap or synapse to the next cell or group of neurons. To do this the neuron releases tiny amounts of a neurotransmitter into the gap toward the next nerve cell, which picks the neurotransmitters up and sends them to the next neuron in the same way.
After carrying a message, the neurotransmitter is usually reabsorbed by the pre-synaptic neuron — known as “re-uptake”. It’s thought that SSRIs work by blocking or inhibiting the re-uptake, leaving the neurotransmitters in the synaptic cleft or gap longer.
However, the problem is that the brain and body tend to work to maintain “homeostasis” or equilibrium. After a person takes an SSRI or SNRI there will be excess serotonin in the synapse. The brain will try to rectify this situation, because it wants to achieve homeostasis. So the post-synaptic neuron tries to address the imbalance of neurotransmitters in the synaptic cleft by growing more receptor sites so that it can absorb the excess serotonin or norepinephrine. The longer a person takes the drugs, the more the brain will grow new receptors to try to fix “the problem.”
This means doses of drugs often have to be increased to have the same effect. It also means that withdrawal can be extremely difficult, as the brain tries to manage with less and less serotonin or norepinephrine while having grown extra receptor sites. Even a normal amount of neurotransmitters in the synaptic cleft feels inadequate to someone who has been on a depression pill for a long time, leading to withdrawal symptoms.
For information on ADHD drugs affect the brain read this.
For information on how anti-psychotics affect the brain read this.
- Mad In America is a website run by Robert Whitaker, a science journalist and leading advocate for better mental health care. There are numerous articles and resources on the DSM, psychiatric drugs, and the problems of the mental health care system
- Medicating Normal is a documentary film. www.medicatingnormal.com
- RxISK is a free, independent drug safety website to help you weigh the benefits of any medication against its potential dangers. www.rxisk.org
- David Breggin, MD, is a psychiatrist who advocates for safe prescribing and offers many resources and books. Unfortunately, he has gotten into some conspiracy mongering about COVID and vaccines in the past several years, but you can ignore those pages. www.breggin.com
- Dr. Joanna Moncrieff is an author and researcher on the harms of psychiatric drugs: https://joannamoncrieff.com
- Information on people harmed by antidepressants, side effects, and withdrawal. https://www.antidepressantrisks.org
- Inner Compass is a grassroots organization working to provide unbiased information about psychiatric drugs and diagnoses. Runs a forum and withdrawal project. www.theinnercompass.org
- Summary article by Robert Whitaker on Anti-Depressants: How Big Pharma Monetized Depression
Mad In America Resources
Drug Withdrawal Resources
Info on drug withdrawal for therapists. https://prescribeddrug.info
Books for a Deep Dive
Davis, Joseph, (2020) Chemically Imbalanced. University of Chicago Press: Chicago and London.
Kinderman, P. (2014). A prescription for psychiatry: Why we need a whole new approach to mental health and wellbeing. New York, NY: Palgrave Macmillan.
Moncrieff, J. (2008) The Myth of the Chemical Cure. Palgrave Macmillan; Basingstoke.
Vanheule, S. (2014). Diagnosis and the DSM: A critical review. London and New York: Palgrave Macmillan.
Whitaker, R. (2010). Anatomy of an epidemic. New York, NY: Broadway Paperbacks.
Whitaker, R. (2010). Mad In America: Bad science, bad medicine, and the enduring mistreatment of the mentally ill. New York, NY: Basic Books.
Whitaker, R., & Cosgrove, L. (2015). Psychiatry under the influence; institutional corruption, social injury, and prescriptions for reform, New York: Palgrave Macmillan.
1 Lacasse, J. R., & Leo, J. (2005). Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine, 2(12), 1211-1216, p. 1212
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1b Nour, Liu, Dolan, 2022. Functional neuroimaging in psychiatry and the case for failing better. Neuron. 110:16, 2524-2544, Aug. 17, 2022
2 Kapur, S, et al (2012) Why Has it Taken So Long for Biological Psychiatry to Develop Clinical Tests. Molecular Psych 17, 1174-9.
5a Rush, A. J., Trivedi, M. H., Wisniewski, S. R., Nierenberg, A. A., Stewart, J. W., Warden, D., et al. (2006). Acute and longer-term outcomes in depressed outpatients requiring one or several treatment steps: a STAR*D report. Am. J. Psychiatr. 163, 1905–1917. doi: 10.1176/ajp.2006.163.11.1905
6 Mark, T. L., Levit, K. R., & Buck, J. A. (2009). Psychotropic drug prescriptions by medical speciality. Psychiatric Services, 60(9), 1167.
7 Mojtabai, R., & Olfson, M. (2011). Proportion of antidepressants prescribed without a psychiatric diagnosis is growing. Health Affairs, 30(8), 1434-1442. doi:10.1377/hlthaff.2010.1024, p. 1434
11 Angermeyer, M. C., Holzinger, A., Carta, M. G., & Schomerus, G. (2011). Biogenetic explanations and public acceptance of mental illness: systematic review of population studies. The British Journal of Psychology, 199, 367-372. doi:10.1192/bjp.bp.110.085563
20 Montejo, A. L., Llorca, G., Izquierdo, J. A., & Rico-Villademoros, F. (2001). Incidence or sexual dysfunction associated with antidepressant agents: A prospective multicenter study of 1022 outpatients. The Journal of Clinical Psychiatry.
21 Simonsen, A. L., Danborg, P. B., & Gøtzsche, P. C. (2016). Persistent sexual dysfunction after early exposure to SSRIs: Systematic review of animal studies. International Journal of Risk & Safety in Medicine, 28(1), 1-12
22 Breggin, P. R. (2013). Psychiatric drug withdrawal: A guide for prescribers, therapists, patients, and their families. New York: Springer.
23 Sharma, T., Guski, L. S., Freund, N., & Gøtzsche, P. C. (2016). Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports. BMJ, 352, i65. doi:10.1136/bmj.i65
24 Bielefeldt, A. Ø., Danborg, P. B., & Gøtzsche, P. C. (2016). Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers. Journal of the Royal Society of Medicine, 109(10), 381–392. doi:10.1177/0141076816666805
25 Moore, T. J., Glenmullen, J., & Furberg, C. D. (2010). Prescription drugs associated with reports of violence towards others. PLoS ONE, 5(12), e15337. doi:10.1371/journal.pone.0015337
25 a Nevels RM, Gontkovsky ST, and Williams (2016) Paroxetine—The Antidepressant from Hell? Probably Not, But Caution Required. Psychopharmacology Bulletin 46:77-104.25 b The distribution of muscarinic M1 receptors in the human hippocampus. Scarr E, Seo MS, Aumann TD, Chanad G, Everall IP, Deana (2016) Journal of Chemical Neuroanatomy 77:187–192.
25 c https://en.wikipedia.org/wiki/Paroxetine#Pharmacology
25 d Finkel MS, Laghrissi-Thode F, Pollock BG, and Rong (1996) Paroxetine is a novel nitric oxide synthase inhibitor. Psychopharmacol Bull. 32:653-8.
25e Brackley AD and Jeske NA (2022) Paroxetine increases delta opioid responsiveness in sensory neurons. eNeuro. 9:ENEURO.0063-22.202 2.
25 f Wang CS, Kavalalin ET, and Monteggia LM (2022) BDNF signaling in context: From synaptic regulation to psychiatric disorders, Cell 185:62-76
26 Gøtzsche, P. C. (2015). Deadly psychiatry and organised denial. Copenhagen: People’s Press.
30 Reisman, 2020
31 Anatomy of an Epidemic, Robert Whitaker, 2011
33 Haime, Z., Watson, A., Crellin, N., Marston, L., Joyce, E., Moncrieff, J. (2021). “A Systematic Review of the Effects of Psychiatric Medications on Social Cognition.” (Preprint). 10.21203/rs.3.rs-651572/v1(Link)
34 Efficacy and Effectiveness of Antidepressants. Pigott, H., Psychotherapy and Psychosomatics 79 (2010):267-279.) Would you take a drug with a 3% effectiveness rate?
35 Course of depressive symptoms over followup. Shea, M., Archives of General Psychiatry 49 (1992):782-87.
41 Leo, J., Lacasse, J.R. The Media and the Chemical Imbalance Theory of Depression. Soc 45, 35–45 (2008). https://doi.org/10.1007/s12115-007-9047-3
43 (The naturalistic course of major depression in the absence of somatic therapy. Posternak, M., Journal of Nervous and Mental Disease 194 (2006):324-9.