Editor’s Note: Over the next several months, Mad in America will publish a serialized version of Peter Gøtzsche’s book, Mental Health Survival Kit and Withdrawal from Psychiatric Drugs. In this blog, he begins a discussion about discontinuing psychiatric drugs. Each Monday, a new section of the book will be published, and all chapters will be archived here.
As noted above, it took almost 30 years before the psychiatric profession and the authorities admitted that benzodiazepines are highly addictive. Propaganda is highly effective, and the reason it took so long is that it was a big selling point for the drug industry that they were not additive, in contrast to the barbiturates that they replaced, just as it became a big selling point around 1988 that the newer depression pills were not addictive, in contrast to the benzodiazepines they replaced.
The lies do not change, for the simple reason that the drug industry doesn’t sell drugs but lies about drugs, which is the most important part of their organised criminal activities.1 The industry is so good at lying that it took about 50 years before the authorities finally admitted that the depression pills are also addictive. Even after this colossal delay, they are not yet ready to call a spade for a spade. They avoid using words like addiction and dependency and talk about withdrawal symptoms instead.
The worst argument I have heard—from several professors of psychiatry—is that the patients are not dependent because they don’t crave higher doses. If true, this would be good news for smokers who, after smoking a pack of cigarettes every day for 40 years can stop overnight, without abstinence symptoms.
Patients don’t care about the academic wordplays whose only justification is to allow the drug companies to continue to intoxicate whole populations with mind-altering drugs. The patients know when they are dependent (see Chapter 2); they don’t need a psychiatrist’s approval that their experience is correct, and some say the withdrawal from a depression pill was worse than their depression.2
Progress is very slow. In a 2020 BBC programme, the mental health charity Mind said it is signposting people to street drug charities to help them withdraw from depression pills because of the lack of available alternatives. Alas, homage is always paid to the wrong ideas people have been brainwashed into believing: “Although they are not addictive, they can lead to dependency issues,” a voice-over told the viewers. Haven’t we heard enough nonsense by now?
One of the most meaningful things a doctor can do is to help some of the hundreds of millions of people come off the drugs they have become dependent on. It can be very difficult. Many psychiatrists have told me that it is much easier to wean off a heroin addict than to get a patient off a benzodiazepine or a depression pill.
The biggest obstacles to withdrawal are ignorance, false beliefs, fear, pressure from relatives and health professionals, and practical issues like the lack of medicines in appropriately small doses.
Very few doctors know anything about withdrawal and make horrible mistakes. If they taper at all, they do it far too quickly because the prevailing wisdom is that withdrawal is only a problem with benzodiazepines and because the few guidelines that exist recommend far too quick tapering.
The situation in the UK improved in 2019 (see Chapter 2) but I have seen no improvements yet in other countries and here is an example. In November 2019, the Danish National Board of Health issued a guideline about depression pills to family doctors, which was enclosed in the Journal of the Danish Medical Association, ensuring everyone would see it.
The sender was “Rational Pharmacotherapy,” but it wasn’t rational. As the guidelines are dangerous, I wanted to warn people against them, but I knew from experience that it doesn’t work to complain to the authorities, which think they are beyond reproach. I therefore published my criticism in a newspaper.3 The Board of Health was given the opportunity to respond but declined—another sign of the arrogance at the top of our institutions, as it is a highly important public health issue.
Although the author group for the guideline included a psychiatrist and a clinical pharmacologist, they didn’t seem to know what a binding curve for depression pills to receptors looks like. As with other medicines, it is hyperbolic. It is very steep in the beginning when the dose is low, and then flattens out and becomes almost horizontal at the top (see figure).4
This is important to know. The board recommends halving the dose every two weeks, which is far too risky. At usual dosages, most receptors are occupied because we are at the top of the binding curve where it is flat. Since virtually all patients are overdosed, they might remain on the flat part of the binding curve after the first dose reduction and not experience any withdrawal symptoms. It could therefore be okay to halve the dose the first time.
But already the next time, when going from 50% of the starting dose to 25%, things can go wrong. Should the withdrawal symptoms not occur this time either, they will almost certainly come when you take the next step and come down to 12.5%.
Hyperbolic relationship between receptor occupancy and dose of citalopram in mg
It is also too fast for many patients to change the dose every two weeks. The physical dependence on the pills can be so pronounced that it takes months or years to fully withdraw from the pills.
Fast withdrawal is dangerous. As noted earlier, one of the worst withdrawal symptoms is extreme restlessness (akathisia), which predisposes to suicide, violence and homicide.
A withdrawal process should respect the shape of the binding curve, and therefore become slower and slower, the lower the dose. These principles have been known for decades and were explained in an instructive paper in Lancet Psychiatry on 5 March 2019 by Horowitz and Taylor.4 Since my colleagues, who have withdrawn many patients, and I have written repeatedly about the principles in national Danish newspapers and elsewhere since 2017, there was no excuse for the people working at the National Board of Health for not knowing about them.
Psychiatric drugs are the holy grail for psychiatrists, and they are the only thing that separate them from psychologists, apart from their qualification as doctors. You would therefore expect huge pushbacks from the psychiatric guild and its allies when you tell people the truth about these drugs and start educating them about how to safely withdraw from them.
This happened to me, on many occasions. As noted in Chapter 2, my opening lecture at the inaugural meeting for the Council for Evidence-based Psychiatry in 2014 was immediately attacked by the top of British psychiatry. The Council was established by filmmaker and entrepreneur Luke Montagu who had suffered horribly from withdrawal symptoms for many years after he came off his psychiatric drugs, and he wanted to highlight their harms.
I mentioned Luke’s name in 2015 in an article I was invited to write for the Daily Mail.5 It came out two weeks after I had published my psychiatry book where all the evidence was.6 The editor made many changes to my article and insisted that I added this statement: “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.”
My research was publicly denigrated by the Cochrane leaders who uploaded a statement that is still up.7 They claimed that my statements about psychiatric drugs and their use by doctors in the UK could be misconstrued as indicating that I was conducting my work on behalf of Cochrane. They also said that my views on the benefits and harms of psychiatric drugs were not those of the organisation.
Cochrane has three mental health groups that have published hundreds of seriously misleading systematic reviews of psychiatric drugs where the authors did not pay enough attention to the flaws in the trials but acted as the mouthpiece of the drug industry.6
Cochrane tried to disavow my conclusions about psychiatric drugs, but the organisation cannot have any “views” on such issues that carry more weight than those of a researcher who has studied them in detail. But the tactic worked, of course. Five days after they uploaded their statement, BMJ published a news item, “Cochrane distances itself from controversial views on psychiatric drugs.”7
Both then and subsequently, Cochrane’s support of the psychiatric guild and the drug industry was widely abused by leading psychiatrists. David Nutt (see more about him in Chapter 2) said during a lecture in New Zealand in February 2018 that I had been kicked out of Cochrane. He was seven months premature.7
Luke wrote about his own “career” as a psychiatric patient in the Daily Mail article.5 The symptoms were of such a nature and severity that I at first found it hard to believe him. I had never learned about anything remotely similar to this during my medical studies or later. But I quickly realised that Luke was not kidding and had no psychiatric condition whatsoever but was a lovely person who had unwittingly fallen into the psychiatric drugging trap.
Luke, heir to the Earl of Sandwich, had a sinus operation at age 19 that left him with headaches and a sense of distance from the world. His family physician told him he had a chemical imbalance in his brain. The real problem was probably a reaction to the anaesthetic, but Luke was prescribed various depression pills that didn’t help.
None of the other doctors and psychiatrists Luke consulted listened either when he said it had begun with the operation. They offered him different diagnoses, and all gave him drugs; nine different pills in four years. As it so often happens, Luke reluctantly concluded that there was something wrong with him. He tried to come off the drugs a couple of times but felt so awful that he went back on them. He thought, which is also typical, that he needed the medication although what happened was that he went into withdrawal each time.
In 1995, he was given Seroxat (paroxetine) and took it for seven years. When he tried to come off it, he felt dizzy, couldn’t sleep and had extreme anxiety. Thinking he was seriously ill, he saw a psychiatrist who gave him four new drugs, including a sleeping pill. He quickly felt better, not realising he had become “as dependent as a junkie on heroin.”
He functioned okay for a few years, but gradually became more and more tired and forgetful. So, in 2009, believing it was due to the drugs, he booked into an addiction clinic. His psychiatrist advised him to come off the sleeping pill right away and within three days he was hit by a tsunami of horrific symptoms—his brain felt like it had been torn in two, there was a high-pitched ringing in his ears and he couldn’t think.
This was horrible malpractice. Rapid withdrawal from long-term use of a sleeping pill is a disaster. The detox was the start of nearly seven years of hell. It was as if parts of his brain had been erased.
Three years later, he very slowly began to recover, but he still had a burning pins and needles sensation throughout his body, loud tinnitus and a feeling of intense agitation.
When I last met with Luke, in June 2019, he was still suffering from withdrawal symptoms but was able to work full time.
He is determined to try to help others avoid the terrible drugging trap. After setting up the Council, Luke founded the All-Party Parliamentary Group on Prescribed Drug Dependence (APPG), which successfully lobbied the British Government to recognise the issue. He recruited the British Medical Association and the Royal College of Psychiatrists to support this. That led to a ground-breaking review by Public Health England with several key recommendations, including a national 24-hour helpline and withdrawal support services.8
These recommendations do not only focus on the traditional culprits, opiates and benzodiazepines, but also on depression pills. In December 2019, the APPG and the Council published the 112-page “Guidance for psychological therapists: Enabling conversations with clients taking or withdrawing from prescribed psychiatric drugs.”9 This guide is very detailed and useful, both in relation to the drugs it describes and in terms of the concrete guidance it offers to therapists.
It became more and more difficult to ignore the huge problem with patients who are dependent on depression pills. In 2016, I co-founded the International Institute for Psychiatric Drug Withdrawal (iipdw.org), based in Sweden. We have had several international meetings and have established a network of like-minded people in many countries, and the interest in finally doing something is spreading fast.
I have lobbied speakers on health in the Danish Parliament for over 10 years and they were always positive when I explained why major changes are needed in psychiatry. But they are afraid of going against the psychiatrists who are quick to tell them that psychiatry is outside their area of expertise. Therefore, nothing substantial has happened.
In December 2016, there was a hearing in Parliament about why withdrawal from psychiatric drugs is so important and how we should do it, which was also the title for my talk. There were contributions from a psychologist and a pharmacist with experience in withdrawing drugs and from a patient relative. There wasn’t a single psychiatrist with experience in withdrawal on the programme.
The only psychiatrist was Bjørn Epdrup who explained when and why neuroleptics are needed—and forgot to tell us when they are not needed—and he said that he could see schizophrenia on a brain scan. This isn’t possible. Scanning studies in psychiatry are highly unreliable,6 but Epdrup left the meeting before anyone could confront him with his claim. The only thing that can be seen on a brain scan is the shrinking of the brain that neuroleptics have caused!6,10,11
In January 2017, I was invited to give a talk at a meeting about overdiagnosis and overtreatment in psychiatry in Sherbrooke, Canada. The meeting was accredited and counted in the physicians’ continued education portfolio. Even though most of audience were psychiatrists, 74 of the 84 participants felt my presentation had responded to their needs. I had not expected this, particularly not after the somewhat tense discussion.
I felt a change was on its way. Two months later, psychologist Allan Holmgren and a political party arranged a conference in Parliament with the theme: “A psychiatry without drugs.” Robert Whitaker lectured about the psychiatric drug epidemic and my title was also direct: “The myth about biological psychiatry: The use of psychiatric drugs does far more harm than good.”
To read the footnotes for this chapter and others, click here.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.