When Psychiatry is Debated, it Becomes an 'Attack'.

Mommy, make them stop!

I laughed hard upon reading a recent article published in The Lancet Psychiatry [27 May 2014
doi:10.1016/S2215-0366(14)70232-9]

You see, there's a bunch of psychiatrists who are taking umbrage to those that oppose unwarranted use of antidepressants. The psychiatrist argument smacks of total hypocrisy and lacks any scientific data, preferring instead to quote hearsay whilst using the defence of antidiagnosis and antitreatment groups attacking their belief system [because that's all it is, a belief.]

What's remarkable about this article is pretty much summed up in its final paragraph. My thoughts on this later.

Here we have 5 professionals putting their name to an article, namely, David J Nutt, Guy M Goodwin, Dinesh Bhugra, Seena Fazel and Stephen Lawrie.

They claim they are being targeted by an anti-psychiatry movement when, in fact, they are being asked to debate the issue of antidepressants publicly.

This latest stunt from David J Nutt et al just highlights how psychiatry, when backed into a corner, does everything to avoid going head to head in a public forum with people that disagree with them.

Rather than enter into a public debate they choose to deflect their cowardice by playing the victim.

"Psychiatry is used to being attacked by external parties with antidiagnosis and antitreatment agendas."

"Most of these people are depressed and more than 70% are not taking an antidepressant at the time of death. Blanket condemnation of antidepressants by lobby groups and colleagues risks increasing that proportion"

"Antipsychiatry groups usually claim that depressed patients should be treated with exercise and psychotherapy instead of drugs. However, little controlled evidence exists to support the use of psychotherapy as an alternative to antidepressants in major depression."

"...the anti-psychiatry movement, although now long in the tooth, has revived itself with the recent conspiracy theory that the pharmaceutical industry, in league with psychiatrists, actively plots to create diseases and manufacture drugs no better than placebo."

Nutt et al are so far of the mark here. There are many individuals, myself included, who are not part of groups - choosing instead to go it alone, to speak out against something because it's the right thing to do.

What I find worrying about this article is the bare-faced cheek of it's authors who dismiss claims that the pharmaceutical industry is in league with psychiatrists and then, because the Lancet abide by transparency, reveal the authors ties to the industry.

{Insert canned laughter here}

DJN has received grants and personal fees from Lundbeck and GSK; and personal fees from Lilly, BMS, Otsuka, Servier, and Pfizer. GMG has received grants and personal fees from Servier and Lundbeck; personal fees from Teva, Otsuka, Takeda, Eli Lilly, Merck, GSK, and AstraZeneca; and grants from P1vital. SL has received research funding from Abbvie, Roche, and Pfizer in connection with genetic, brain imaging, and therapeutic studies of people with schizophrenia. He has also been paid by Janssen and Roche to speak at or chair educational meetings about schizophrenia, as well as to contribute to advisory boards about new antipsychotic treatments. The other authors declare no competing interests.

It's laughable.

It's akin to the following hamster claiming that he doesn't know where the carrots are.

And we, the gullible public, are expected to believe Nutt et al because [boo hoo] they are being targeted by antipsychiatry groups.

If Nutt had anything about him, he'd step up to the plate and publicly debate what he thinks he knows about antidepressants and their safety - instead he, with his colleagues, run to the Headmaster because they cannot answer their critics in a public place - ergo they are being bullied, targeted by academics who have different opinions.

"Mommy, make them stop."

A few weeks ago Professor Peter Gøtzsche, Nordic Cochrane Centre, Dr Joanna Moncrieff, University College London and Dr James Davies, University of Roehampton challenged Nutt et all to an open debate. All three are part of The Council for Evidence Based Psychiatry [CEP] - the clue to what they seek is in the title of their organisation - "Evidence Based Psychiatry".

One way to put a stop to this is to stop the pissing match. Go public, sit on a panel - Gøtzsche et al on one side of the table, Nutt et al on the other side.

What we are currently witnessing is fight-hype, we see this, normally in Boxing. Two fighters talk the talk before beating one another in the ring. Difference being, they get in the ring to iron out their problems.

The CEP have challenged Psychiatry but Psychiatry is making excuses, they want to keep their heavy-weight belt and fear they will lose it if they accept the challenge.

We have the CEP in one corner here and Nutt et al in another. The CEP are ready to exchange blows but Nutt et al want protection from the referee. "The CEP are anti-me Mr Referee, do I have to fight them?"

In 2004 Nutt held 300 shares in GlaxoSmithKline and was also a paid consultant for them. It's a pity Nutt didn't add this in his article in the Lancet.

The Lancet Psychiatry article, Attacks on antidepressants: signs of deep-seated stigma?, can be read here [registration needed]

Bob Fiddaman

CEP Lays Down Gauntlet to Prescribing Psychiatrists

Will Professor Nutt et al accept the invitation from the CEP for a debate on antidepressants?

The Council for Evidence Based Psychiatry [CEP] has laid down the gauntlet to a handful of psychiatrists who, it appears, believe antidepressant use can prevent suicide.

Last week Professor David Nutt, Professor Sir Simon Wessely and other senior psychiatrists responded to an article in The Times written by  Health Correspondent, Chris Smyth.

Smyth quoted CEP Co-Founder Peter Gøtzsche in his article and this evoked a response from a number of psychiatrists who replied in a letter to The Times.

Sir, Depression can be a debilitating and lethal illness. Medication is a vital part of the treatment of the severest cases. Successful treatment with antidepressants definitely does not do “more harm than good” as you report (Apr 30).

We do not dispute that these drugs are of potentially less value for mild depression, but their effectiveness is maintained as the severity of the depression increases. Is that true of psychological treatment or exercise?

Depression is serious: 6,500 people commit suicide each year in the UK. Many of them are never offered antidepressants, and the blanket condemnation of antidepressants by Professor Peter Gøtzsche and colleagues will increase that proportion.

Professor David Nutt, Neuropsychopharmacology Unit, ICL

Professor Stephen Lawrie, Division of Psychiatry, Edinburgh

Professor Sir Simon Wessely, Royal College of Psychiatrists

Dr Seena Fazel, University of Oxford

Professor Guy Goodwin, European College of Neuropsychopharmacology

Professor Dinesh Bhugra, World Psychiatric Association

In response to the letter from Nutt et al, Peter Gøtzsche,  Dr Joanna Moncrieff and Dr James Davies, of the CEP, wrote...

Sir, Further to the letter from Professor David Nutt and others, whatever the evidence on the efficacy of antidepressants — and the effects are weak even in severe depression — there is no doubt these drugs are being widely overprescribed, and not enough attention is being paid to the harms they can cause. We do not accept that reducing antidepressant prescribing will increase the number of suicides. Antidepressants have not been shown in reliable studies to reduce suicide, indeed they increase the risk of suicide in young people. There is also evidence that antidepressants may increase a whole range of adverse events in the elderly, including falls and fractures, and are associated with increased mortality.

Given these factors and the tendency of many psychiatrists to downplay the harms of overprescribing such medications, we invite Professor Nutt and his colleagues to a public debate where these views can be properly aired.

Professor Peter Gøtzsche, Nordic Cochrane Centre

Dr Joanna Moncrieff, University College London

Dr James Davies, University of Roehampton

Nutt et al have, so far, failed to reply to the invitation. I'd be really surprised if they take the gauntlet laid down by Messrs Gøtzsche, Moncrieff and Davies - Nutt et al have been backed into a corner here - if they come out with guns blazing they are liable to make themselves look silly. Using the defence that antidepressants prevent suicide in their initial letter to The Times was  textbook psychobabble. They go down this route in the hope that patients, both past and present, support their claims with statements such as "Antidepressants saved my life" or "If it wasn't for antidepressants I'd probably be dead". Both statements come from the type of patient who, for whatever reason, have been duped into believing the claims of clever marketing, key opinion leaders [paid by the industry] and a fear that they just cannot get through the day without their daily fix of Prozac type drugs.

Nutt et al have now been publicly challenged to offer proof of this. To my knowledge, there is no proof that antidepressants can prevent suicide, in fact the evidence suggests that antidepressants actually can induce suicide.

Hats off to the CEP for showing how predictable the pro-pill brigade can be when one questions the safety and efficacy of antidepressants.

Incidentally, I wrote about David Nutt some years ago. Nutt was part of the Committee on the Safety of Medicines (CSM), an apparent independent body who have, for 40 years, advised the UK Licensing Authority on the quality, efficacy and safety of medicines - In other words they offered advice to the MHRA.

In 2004 Nutt held 300 shares in GlaxoSmithKline and was also a paid consultant for them. It's a pity Nutt didn't add this in his letter to The Times.

So, does Nutt have the bottle to get into a public debate about the safety of antidepressants?

Will he shy away because of his paid consultancy from GlaxoSmithKline and the shares he once held may be used against him and make his argument very weak. Will he and his colleagues be able to back up their claims with actual science or are their claims, as I suspect, just a theory based loosely around the pandemic promotion of these groups of medicines.

We have six pro pill pushers in Nutt, Lawrie, Wessely, Fazel, Goodwin and Bhugra. How long will we have to wait before the likes of Robert Gibbons and Patricia Casey poke their noses into something that appears to have upset those who choose to drug rather than look at the evidence that, for the majority, shows that these drugs just don't work.

My money is on Nutt et al declining the offer of a public debate. Why would they accept the offer to be publicly humiliated by scientific fact?

You can see the exchange of letters between the CEP and Nutt et al here.


Bob Fiddaman