‘First they ignore you. Then they ridicule you. And then they attack you …’*

Summary:

I respond to some of the points in the recent Rolling Stone article and correct the many inaccuracies and distortions. 

Ignoring is no longer working, so champions of big Pharma and mainstream psychiatry have gone into attack mode. The strategy is to undermine the messenger (me) in order to neutralise the message. In this case the message is the bombshell that there is no evidence that depression is a brain chemical imbalance and antidepressants do not do what people have been told they do. In fact, the scientific community does not know what antidepressants do but, they reassure people, they still ‘work’ so it doesn’t matter.

Apparently our finding is so obvious that it ‘was met with yawns by the psychiatric community’. Yet the public were kept in the dark about the lack of evidence for a chemical imbalance for three decades in what an Australian psychiatrist recently called a ‘scourge on our profession’. And the public are very interested. The original paper is in the top 500 most shared scientific papers of the 21 million that have even been tracked, and our article about it in the Conversation has had over a million views.

In a time-honoured tactic, the article attempts to discredit me by association. But now it is not just the Scientologists, although they are thrown in for good measure (and for the record I have never had any association with the Scientologists), but the ‘right-wing media’. The article points out that right wing commentators such as Tucker Carlson and Matt Walsh have covered our research. It goes on to suggest that I have ‘promoted.. the belief that SSRIs are linked to aggressive behaviour’, which is described as a ‘fringe view’ that has been used by right wing media to argue against gun controls in the US in the wake of school shootings. What I actually did was comment on research published in the British Medical Journal (BMJ) that found links between antidepressants and aggressive behaviour (as well as suicide) in young people. My comments were published in an invited editorial in the BMJ, and also on my blog. I hardly think this is ‘promoting’ anything, certainly not a ‘fringe view’.

The journalist does present my response to these issues, but bringing them up seems to suggest that because of this we should never have publicised or maybe even done our research. This amounts to the suggestion that millions of people should be denied information about the drugs they put in their body every day because the message might be taken up by the ‘wrong’ people.

The article accuses me of ‘promoting widely disputed beliefs about the dangers of various mental health interventions such as antidepressants or alternative forms of treatment’. This is not accurate. Most of the adverse effects I have highlighted in my research are widely recognised, and those that are less well-recognised (such as post SSRI sexual dysfunction- which is now recognised officially by the European Medicines Agency) have not been ‘widely disputed,’ or indeed disputed at all.

One example given is that I supposedly ‘inaccurately linked’ Transcranial Magnetic Stimulation (TMS) treatment to an increased risk of cognitive impairment. I was surprised by this as I have never written about TMS or done any research on it. Then I saw that the link in the article referred to one tweet I did of a blog about a Facebook group where hundreds of patients report side effects of TMS, including cognitive impairment. Although cognitive impairment is not recognised currently as a side effect of TMS, we know that many adverse effects are reported by patients before they are detected or measured accurately in scientific studies (such as antidepressant withdrawal). In any case, it was not made clear that this accusation was based on a single tweet and not on any of my writing or research.

Another example is that I have apparently ‘aggressively championed the idea that SSRIs can cause lasting structural damage to the brain, authoring multiple papers to that effect’. It is highly misleading to omit the context here, and in fact the majority of the papers that are linked to do not make any claim about structural damage. In one invited editorial, I made the following suggestion ‘The brain is a delicate organ; it may not take much to permanently re-set its structure or function.’ My editorial discussed two other papers that covered the growing evidence about withdrawal effects and persistent sexual dysfunction reported by people who have stopped antidepressants, which may indicate lasting damage to brain structure or function. Readers surely deserve to have this context. The existence of persistent withdrawal and persistent sexual dysfunction have now been reported in many scientific papers and have not been widely disputed.

Another example provided is that in my blog and research I have ‘promoted the idea that withdrawing from SSRIs can cause long-term mania or psychotic symptoms’. This is completely incorrect. I have never promoted this idea. I have covered the existence of withdrawal symptoms in general, and discussed how these can commonly be severe, but I have never suggested that mania or psychosis were common withdrawal symptoms or ever highlighted these effects (which I agree with others are most likely extremely rare).

The article adds ‘the most common side effects of withdrawal, such as dizziness or gastrointestinal distress, are uncomfortable yet short-lived’. This idea that withdrawal is short-lived is no longer accepted. The Royal College of Psychiatrists website quotes the National Institute of health and social Care Excellence (NICE) saying ‘for some, withdrawal symptoms can be mild and go away relatively quickly, without the need for any help. Other people can have more severe symptoms which last much longer (sometimes months or more).’

Minimising antidepressants withdrawal in this way could lead people to stopping their antidepressants abruptly and suffering severe withdrawal symptoms. 

The article completely misrepresents my views on personal autonomy and health and the essay that I wrote about Szasz’s views on this in 2014. The essay is actually a consideration of the need for paternalism in some situations (i.e. the over-riding of personal autonomy). I actually mention pediatric vaccine mandates as examples of instances in which mandatory public health measures might be justified in the interests of the health and welfare of the population, not the opposite as implied.

The Rolling Stone article goes on to bring up my opposition to the NHS covid vaccine mandate. It claims that I ‘inaccurately connected severe Covid-19 symptoms to antidepressant or antipsychotic use (in fact, data from an observational study suggests that taking SSRIs may actually reduce a person’s risk of dying from Covid)’. This is highly misleading. I tweeted a link to a scientific study authored by the Public Health Scotland COVID-19 Health Protection Study Group which found an increased risk of severe covid with antipsychotics and antidepressants, along with other non-psychiatric drugs such as opioids. It is true that some other studies have suggested reduced mortality in people taking particular antidepressants, but this does not refute the findings of the Scottish study. The data is conflicting, as it so often is in the early stages of research on something. 

The article accuses me of having ‘dabbled in the same vein of light conspiratorial thinking’ with antidepressants as with the vaccines, but if my suggestion that financial motives along with ‘psychiatrists’ professional insecurity, and doctors’ perceived need to have something to offer’ have influenced research on antidepressants counts as conspiratorial thinking, then the whole of academic sociology, politics, history and a large amount of mainstream journalism consists of conspiratorial thinking.    

And to clear up a final issue, psychiatrist Awais Aftab suggests that I have ‘challenged the characterization of depression as a mental illness’. In serious philosophical articles published in academic journals, I have questioned whether it is justified, appropriate and helpful to conceive of the suffering and difficulties that we label as mental illness as a brain disease. I have never denied the reality of the suffering or the need to help people who are experiencing it.

Notes:

*This statement (often wrongly attributed to Ghandi in a slightly different form) was said by Nicholas Klein of the Amalgamated Clothing Workers of America in 1918.