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"In non-technical, easy-to-understand language, [the authors] bring an incredibly important and hardly ever recognized message to people who need to understand the dark side of psychiatric drugs and how to stop taking them. I heartily recommend [this book]." - Candace Pert, Ph.D., author of Molecules of the Mind
"This is a courageous, compassionate book, and a much-needed antidote to the pro-drug bias of modern psychiatry and psychology." - John Horgan, author of The Undiscovered Mind
"I wish I'd had this book when I was trying to come off psychiatric drugs." - Kate Millett, author of The Loony Bin Trip
"This book is long overdue. Drs. Breggin and Cohen make possible the practice of psychiatry with a conscience." - Bertram P. Karon, Ph.D., Professor of Clinical Psychology, Michigan State University
"In non-technical, easy to understand language, Peter Breggin and David Cohen bring an incredibly important and hardly ever recognized message to people who need to understand the dark side of psychiatric drugs and how to stop taking them. I heartily recommend it."
"Confronting current psychiatric drug prescribing practice head-on is a daunting task - we owe Breggin and Cohen a vote of thanks for openly speaking the truth. Despite what the pharmaceutical companies would have us believe, we don't need `a better life through chemistry?' This book will help debunk this myth and provide practical advice on how to avoid psychiatric drugs and get off them."
"This book is long overdue. Drs. Breggin and Cohen make possible the practice of psychiatry with a conscience."
"The modern medical approach to almost any human problem is to find a drug - a sort of magic bullet - to fix it. But many drugs do more harm than good, and some even cause the problems they are supposed to fix. And once on a drug, coming off may also be dangerous. In this clear and important book, Peter Breggin and David Cohen outline the problems and provide a step-by-step account of how to come off the drug which may be harming you."
"This is a courageous, compassionate book, and a much needed antidote to the pro-drug bias of modern psychiatry and psychology"
"`Your Drug May Be Your Problem' is a clear, accurate, and thorough look at the dangers of psychiatric drugs, and a prudent outline of what steps to take for those who want to stop taking them."
"I wish I had this book when I was trying to come off psychiatric drugs. How wonderful that you have provided this guide."
"Working as a consultant, I am constantly looking for ways to help clients achieve a more educated view regarding psychotropic medication. Breggin and Cohen have assembled a gold mine of information to assist in this process. I can think of no other book that has done such a superb job of making such information accessible at any point of decision regarding taking or discontinuing psychotropic medication."
"This book is one of the most important things that has happened to psychiatry and especially to so-called `psychiatric patients' during this century. Having worked for more than 20 years with so-called schizophrenics - the main victims of the abuse by prescribed psychiatric drugs - I can say that Peter Breggin and David Cohen must be praised for the courage they have had to unmask many pseudo-scientific conclusions frequently present in supposedly scientific literature."
"It has taken great courage for Drs. Breggin and Cohen to write this very significant book. ... As advocates for non-pharmacological approaches ... the authors have outlined a careful and highly responsible program for withdrawal from psychiatric medications."
"This book leads the way in explaining and redefining the growing pathology of the culture of psychiatric medications. It is a reminder of where we are and a non-medical prescription of where we can go."
"One hundred years from now, people will read current psychiatric textbooks with the same incredulity we have about blood-letting and snake oil. `Your Drug May Be Your Problem' will be remembered as the turning point and as the beacon that showed the way out of these dark days of widespread psychiatric drugging. Breggin and Cohen, like trusted friends, provide us with critical information we need to know in order to make informed decisions about psychiatric drugs, including when and how to stop taking them. They present it all within a coherent philosophy of life and health that makes the routine use of psychiatric drugs obsolete. If you have reached that inevitable point of being disillusioned with your psychiatric drug, this book will be your best friend and guide."
"This innovative, informative, and easy-to-read book is a godsend for non- medical people such as parents, teachers, counselors, social workers, and psychologists who need to know the potential dangers of referring their children, students, or clients to physicians for psychiatric medication."
"`Your Drug May Be Your Problem' provides much useful and very practical information, and it is much needed considering that there is such massive propaganda by the pharmaceutical and medical industries about such drugs. This propaganda must be combated, and this book contributes to that effort."
"`Your Drug May Be Your Problem' is an honest and straightforward attempt to present a clear picture of drug effects, why we turn to drugs, their role in society, and more. It fills a real need in our current drug culture and in our current complete trust in the drug dispenser himself. The book's main import will be to serve as a counter-balance to the myth of a `miracle' drug cure. It's a must on everyones bookshelf!"
"I recommend `Your Drug May Be Your Problem' as the number one self-help guide to coming off psychiatric drugs."
"Anyone considering saying `yes' to psychiatric drugs, or wanting to `just say no,' should first say `YES' to buying and reading this essential, informative book. Breggin and Cohen's goal is empowerment of troubled people seeking help, not propaganda, pressure, or profit. This book questions, informs, warns, and leaves the reader far better able to choose wisely."
"I highly recommend this book to persons on psychiatric drugs, and to the physicians who prescribe them. These drugs are very powerful, either for good or for harm. Since the actions for almost all of them are still unknown, the people who use them are being experimented on, mostly without their knowledge. Drs. Breggin and Cohen are experts on the negative effects of drugs. Their views should be just as widely known as the misleadingly positive advocations of the drug companies."
"This groundbreaking book provides a comprehensive and honest source of information about adverse and withdrawal effects of commonly-used psychiatric drugs. It should be in the office of all medical and non-medical 'mental health' workers. It should also be read by anyone considering the use of psychiatric drugs and all those who want to stop."
"Emotional maturity, self-confidence, and life competence come from struggling with stresses, fears, and adversities. When young people become addicted to drugs they remain emotionally immature until they quit and start learning to cope. Breggin and Cohen point out that the same is true of chronic users of psychiatric medications. It is not until they withdraw from the chemical dependency urged on them by psychiatry that they can develop inner strengths for coping with life's difficulties."
"Doctors Peter Breggin and David Cohen take the reader through the risky pathways of psychiatric medication with accurate information as a guide. Dr. Breggin was a voice in the night calling for responsibility with psychiatric medication. Now he leads an orchestra of protest."
"Breggin has been a brave pioneer in not only pointing out but also meticulously documenting the ways that the `Emperor' of traditional mental health treatment is naked. His relentless raising of questions and documentation of false advertising and cover-ups by drug companies and various forms of abuse of patients by a variety of therapists is invaluable and irreplaceable."
"Nowhere does the false medical thinking, that there is a drug cure for almost all common diseases, do more harm than in the modern psychiatric argument that mental illness is easily diagnosed and then cured by a side-effect-free drug. Nowhere is the correct psychiatric thinking more evident than in the books by Peter Breggin. In them he explains clearly that patients with mental illnesses are in almost all instances suffering from their inability to connect with important people in their lives and need help in making these vital connections. He supports safe, drug-free counseling as a more effective way to help people, and I enthusiastically agree with this premised."
Psychiatric drugs are much more dangerous than many consumers and even physicians realize. All of these drugs produce numerous serious and potentially fatal adverse reactions, and most are capable of causing withdrawal problems that are emotionally and physically distressing. Some produce powerful physical dependence and can cause life-threatening withdrawal problems.
Although this is the first book to describe in detail why and how to stop taking psychiatric drugs, it is not intended as a substitute for professional help. Especially when psychiatric drugs have been taken in large doses for prolonged periods of time, experienced clinical supervision may be useful and even necessary during the withdrawal process.
This book is intended for anyone who is thinking about starting or stopping psychiatric drugs. It may also be useful to people who are taking psychiatric medications without any immediate intention of stopping. In addition, it is meant for anyone who has friends or loved ones who are taking these drugs.
Many professionals who are involved with the prescription or monitoring of medication may also find this book useful. The chapters that follow contain basic information about drug hazards and drug withdrawal of which many medical doctors may be unaware - including even those physicians who frequently prescribe psychiatric drugs.
When "Your Drug May Be Your Problem" was originally published in l999 it was the first of its kind-the only book to examine the adverse effects of every class of psychiatric drug and how to safely withdraw from them. With this second edition, our book remains unique in its emphasis but in many ways it has become less controversial. In the past eight years, scientific research and the Food and Drug Administration (FDA) have further confirmed many of the concerns voiced in the first edition, including our emphasis on how antidepressants and stimulants cause harmful mental effects and dangerously abnormal behavior such as psychosis, violence, and suicide.
We have both been very active in scientific research in the intervening years since the first edition of "Your Drug May Be Your Problem". I have published more than a dozen scientific articles and books that further develop and demonstrate many of the observations and concepts described in the first edition of this book1. In recent years, my testimony has been accepted in many additional criminal, malpractice and product liability cases involving the adverse effects of these medications.
The FDA has at long last confirmed the first edition's observations that antidepressants produce dangerous degrees of stimulation with aggressive behavior and that they also produce suicidality in children and adults.
At public hearings in 2004 the FDA presented re-evaluations of antidepressant clinical trials for children and youth under age eighteen documenting that the suicide risk was doubled in children taking antidepressants compared to similar individuals taking a sugar pill. The agency also reported that only one-fifth of controlled clinical trials demonstrated any usefulness for antidepressants in children and youth under age eighteen2. Antidepressants were not only proven ineffective in children and teenagers, they were proven to cause suicide.
The FDA applied its conclusions to all of the newer antidepressants including bupropion (Wellbutrin), citalopram (Celexa), fluoxetine (Prozac, Sarafem), fluvoxamine (Luvox), mirtazapine (Remeron), nefazodone (Serzone), paroxetine (Paxil), sertraline (Zoloft), escitalopram (Lexapro), and venlafaxine (Effexor). A more recent antidepressant, duloxetine (Cymbalta), shares similar risks.
In summarizing the hearings, panel chairman Wayne K. Goodman, M.D. confirmed an emerging "pattern" of "behavioral toxicity" and specifically referred to "activation" or over-stimulation as a root problem. He suggested that symptoms or signs of over-stimulation "may represent a precursor to the symptom we most fear, that of suicide intent". Dr. Goodman reminded the hearing that only 20 percent of the clinical trials showed any effectiveness and warned, "So, in addition to adverse effects that were of concern, we had questions about the overall benefit of this class of agents, raising then naturally questions about benefit/risk ratio" (FDA, 2004b [158]).
On March 22, 2004, the FDA issued a press release along with a public Health Advisory on "Cautions for the Use of Antidepressants in Adults and Children". The agency's press release stated that it is "known" that antidepressants are associated with "anxiety, agitation, panic attacks, insomnia, irritability, hostility impulsivity akathisia (severe restlessness), hypomania, and mania" (FDA, 2004a [157]). Without using the terms stimulation or activation, the FDA for the first time confirmed that antidepressants cause a dangerous pattern of these effects along a continuum from anxiety and agitation through mania.
The FDA published a new required label for all antidepressants on January 26, 2005 including a black box headlined "Suicidality in Children and Adolescents". The warning begins "Antidepressants increased the risk of suicidal thinking and behavior (suicidality) in short-term studies in children and adolescents with Major Depressive Disorder (MDD) and other psychiatric disorders" (FDA, 2005a [159]).
The FDA also added to the label a section entitled "WARNINGS - Clinical Worsening and Suicide Risky" for children and adults. In doing so, the federal agency confirmed my longstanding concern that antidepressants actually worsen the condition of many patients. Antidepressant labels must now warn that adults "should be observed similarly for clinical worsening and suicidality especially during the initial few months of a course of drug therapy or at times of dose changes, either increases or decreases".
The media and the psychiatric profession have focused almost exclusively on the new suicide warnings in antidepressant labels, while the FDA's more far-reaching warnings about over-stimulation have been largely ignored. Every antidepressant label must now warn in detail about over-stimulation or activation. This critical new addition to all antidepressant labels applies to children and adults alike and is found in the section entitled, "WARNINGS-Clinical Worsening and Suicide Risk". Embellishing slightly on the initial FDA press release, the label states that antidepressants are associated with the production of "anxiety agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity akathisia (psychomotor restlessness), hypomania, and mania".
Another section of the new label informs doctors what information should be given to patients and their families. It points to "clinical worsening and suicide" and repeats the description of over-stimulating, adding "and other unusual changes in behavior, worsening of depression, and suicidal ideation".
The FDA also published a special booklet to be included in the labels and to be given to the parents of children placed on antidepressants (FDA, 2005b [160]). In a heading entitled "What to Watch Out For in Children or Teens Taking Antidepressants", the booklet lists twelve psychiatric items with bullets. Almost all of them confirm antidepressant over-stimulation and several specifically mention manifestations of violence and suicidality. Here they are in their entirety:
Immediately after the list, the booklet additionally warns about withdrawal:
"Never let your child stop taking antidepressants without first talking to his or her healthcare provider. Stopping an antidepressant suddenly can cause other symptoms."
After establishing that antidepressants cause suicide in individuals under the age of eighteen, in 2005-2006 the FDA required the drug companies to re-evaluate their data on adult suicidality. As a result, in May 2006 GlaxoSmithKline sent a mass mailing to "Dear Healthcare Professional" [178] warning that Paxil increases the risk of suicidal behavior for adults of all ages who suffer from Major Depressive Disorder as well as for younger adults who suffer from lesser depressive disorders and anxiety disorders (GlaxoSmithKline, 2006 [178]).
On December 13, 2006 the FDA's advisory committee3 met to discuss the overall results of the re-evaluation of adult suicidality data. The FDA concluded that antidepressants cause increased rates of suicidality in people age eighteen to twenty-four taking antidepressants compared to those taking placebo.
The FDA seemingly would like to believe that at age twenty-five people change biologically or psychologically in some fashion so that the antidepressant suicidality warning need not apply to them; but common sense and clinical experience tell us that the risk is increased for all ages. Younger patients may be more likely to have these horrendous adverse drug reactions, but they occur as well in older people. Clinical trials are not meant to detect suicidality and due to their relative insensitivity to the problem, they only identified the greater vulnerability found in younger patients.
All of these "new" FDA observations and conclusions were already available in the first edition of "Your Drug May Be Your Problem". The psychiatric community and the FDA have been slow to catch up with observations that I have been making for decades and that were summarized in the first edition of the book. In 1991 in "Toxic Psychiatry" [49] I first described how Prozac can cause "murderous and suicidal behavior" by means of over-stimulation:
"Prozac often affects individuals as if they were taking stimulants, such as amphetamine, cocaine, or PCP. ... Like amphetamine or cocaine, Prozac can produce the whole array of stimulant effects, such as sleeplessness, increased energy, jumpiness, anxiety, artificial highs, and mania. Some patients taking Prozac do indeed look `hyper' or `tense', and even aggressive, without even realizing it ... , Indeed, the FDAs internal review of Prozac side effects by psychiatrist Richard Kapit twice mentions the drug's `stimulant' effects, but these important observations were not included in the final labeling requirements4."
In many books after 1991, I continued to warn about antidepressant overstimulation, violence, and suicide, drawing upon additional clinical and research studies in "Talking Back to Prozac" (1994) [75], "Brain-Disabling Treatment in Psychiatry" (1997) [55], and finally "The Antidepressant Fact Book" (2002) [66]. I also published scientific papers culminating in 2003 with the most detailed scientific review of the entire subject entitled "Suicidality, violence and mania caused by selective serotonin reuptake inhibitors (SSRIs)".
Meanwhile, in 1997 psychiatrist David Healy [198] joined in with a critique of antidepressants, The Antidepressant Era, further describing the risk of suicidality; and in 2000 psychiatrist Joe Glenmullen [179] wrote Prozac Backlash, extensively documenting the role of antidepressant-induced akathisia (psychomotor agitation) in causing violence and suicide.
The new language required by the FDA in antidepressant labels closely follows the thrust of my observations in my 2003 paper that was distributed to the FDA committee before it drew its conclusions. In that paper I described and documented how the antidepressants cause akathisia and a stimulant syndrome that begins with "insomnia, nervousness, anxiety, hyperactivity, and irritability and then progresses toward more severe agitation, aggression, and varying degrees of mania". Notice the similarity in the concept and language in the new FDA-approved label when it describes antidepressant-induced "anxiety, agitation, panic attacks, insomnia, irritability, hostility, aggressiveness, impulsivity, akathisia (psychomotor restlessness), hypomania, and mania".
It was of course gratifying to witness this outcome after years and years of work, often in the face of professional outrage, judicial hostility and media disbelief; but for untold millions of patients and their families, the warnings came much too late.
How are we to account for such a long lag in the FDA's recognition of antidepressant-induced over-stimulation, as well as hostility aggression, and suicidality? Most obviously the drug companies and the FDA want to protect themselves from being criticized for denying problems that some of us have been warning about since the early 1990s. More insidiously, as I have recently documented on my Web site and in Ethical Human Psychology and Psychiatry concerning Paxil and GlaxoSmithKline, drug companies make extreme efforts to hide incriminating data about their drugs from the FDA, the health professions, and the public5.
As we emphasized in the first edition of this book, all antidepressants can cause emotionally and physically distressing and dangerous withdrawal reactions. Because of a wide variety of symptoms from severe shock-like headaches to overwhelming depression, many patients feel they cannot stop taking them6.
Paxil produces some of the worst withdrawal reactions but GlaxoSmithKline, the manufacturer of the antidepressant, has fought recognizing the severity of these problems. A few years ago I was a consultant in a California suit to force the manufacturer of Paxil to increase its warnings concerning withdrawal. Attorney Don Farber of San Rafael reported to me that the company "resolved the case" satisfactorily a pharmaceutical industry euphemism for settled without admitting guilt. . Simultaneously under pressure from the FDA, the company upgraded the warning with a bold black heading, "Discontinuation of Treatment with PAXIL". The label now summarizes reports that it has received concerning withdrawal reactions7:
"Dysphoria [painful] mood, irritability agitation, dizziness, sensory disturbances (eg., parethesias such as electric shock sensations), anxiety confusion, headache, lethargy, emotional lability, insomnia, and hypomania. While these events are generally self-limiting, there have been reports of serious discontinuation symptoms."
The new antidepressant label notes that the withdrawal symptoms can become "intolerable". Consistent with our earlier suggestions in the first edition of this book, GlaxoSmithKline now recommends slow withdrawal with resumption of the previous dose if the suffering becomes intolerable.
In "Toxic Psychiatry" [49] in 1991 and again in more detail in "Talking Back to Prozac" in 1994 [75], I documented that antidepressants are so ineffective that even drug company-rigged studies have difficulty showing any positive effects. I pointed out that the drugs are little better than sugar pills and that the slightly better performance of the antidepressants in short-term clinical trials is due to many extraneous factors including investigator bias and the manipulation of data. Recent research has confirmed these observations.
In 2002 a team led by psychologist Irving Kirsch [231] at the University of Connecticut published an analysis of efficacy data submitted to the FDA between 1987-1999 for Prozac, Paxil, Zoloft, Effexor, Serzone, and Celexa (Kirsch et al., 2002 [231]; Also see Kirsch and Sapirstein, 1998 [230]). In order to approve a drug, the FDA requires only two positive studies, but drug companies invariably have to conduct many clinical trials before they can come up with a couple of positive clinical trials. Kirsch and his colleagues looked at all the studies conducted by the companies-not merely those used to get approval by the FDA. After analyzing the entire group of antidepressant clinical trials conducted by the drug companies, Kirsch and his colleagues concluded that there was little or no evidence that the drugs worked. Their research demonstrated that any beneficial or positive effects in comparison to placebo were "negligible".
In 2006 Joanna Moncrieff [283] and Kirsch published another review and analysis of antidepressant efficacy in the BMJ (British Medical Journal) focusing on SSRIs such as Prozac, Zoloft, and Paxil. They concluded that these drugs "do not have a clinically meaningful advantage over placebo".
The first edition of "Your Drug May Be Your Problem" also emphasized the dangers associated with the stimulant drugs used to treat Attention Deficit Hyperactivity Disorder (ADHD). As Brian Kean (2005 and 2006 [222]) has amply documented, a worldwide marketing campaign continues to expand the number of children whose basic human rights are being trampled by unscientific diagnoses and toxic treatments. Meanwhile, the FDA has admitted that these medications are far more dangerous than previously admitted. The relatively benign FDA-approved labels for stimulant drugs such as Adderall, Dexedrine, Ritalin, and Concerta have misled physicians and the public into underestimating their hazards. Few professionals or consumers realize how addictive the drugs can be and even fewer realize that they frequently cause serious psychiatric side effects such as psychosis, mania, aggression, and suicide.
In 2005 the FDA finally acknowledged that it was receiving numerous reports of stimulant-induced harmful psychiatric effects such as psychosis, visual hallucinations, suicidal ideation, aggression, and violence (FDA, 2005d [162], 2006 [163]). Then in early in 2006 the FDA's Division of Drug Risk Evaluation issued an alarming report that declared8:
"The most important finding of this review is that signs and symptoms of psychosis or mania, particularly hallucinations, can occur in some patients with no identifiable risk factors, at usual doses of any of the drugs currently used to treated ADHD. Current labeling for drug treatments of ADHD does not clearly address the risk of drug-induced signs or symptoms of psychosis or mania (such as hallucinations) ... A substantial proportion of psychosis related cases were reported to occur in children age ten years or less, a population in which hallucinations are not common."
Their data was derived from all the drugs involved in treating ADHD, including Strattera, amphetamine (Adderall and Dexedrine) and methylphenidate (Focalin, Concerta, Metadate, Methylin, Ritalin, and methylphenidate skin patches). It also included Provigil, a drug sometimes used as a stimulant. A complete list can be found in the Appendix.
The FDA's report also identified stimulant-induced aggression, including many cases that were "considered life-threatening or required hospital admission". It noted that the FDA had already placed a suicide warning in the Strattera label (FDA, 2005c [161]) and it warned with less conviction that the other stimulants showed signals of causing suicidality.
With these observations and warnings about stimulant drugs, the FDA began to catch up with warnings I had first issued in 1998 as the scientific presenter on adverse drug effects in children at the Consensus Development Conference on the Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder, a highly publicized meeting sponsored by the National Institutes of Health (NIH)9. In my published report and my presentations to the conference I specifically warned about an unexpectedly high number of cases of stimulant-induced psychosis, aggression, and suicidality. Using an earlier version of the same data that the FDA recently relied upon-reports sent to it from various sources - by 1998 I had already found hundreds of psychiatric adverse drug reactions such as agitation, hostility, depression, psychotic depression, psychosis, hallucinations, emotional lability, and abnormal thinking. I also reported on finding many cases listed as overdose, intentional overdose, and suicide attempt. I enlarged upon this warning in "Psychostimulants in the treatment of children diagnosed with ADHD: Risks and mechanism of action" (1999) and in "Talking Back to Ritalin" (2001)10.
Why was I able to pick up the signal in 1998, while the drug companies never found it and the FDA only became aware in 2005? I was looking for potential problems from the drugs while the drug companies and the FDA were looking away from them.
Ultimately the FDA failed in its initial promises to seriously upgrade its warnings about the newly recognized adverse psychiatric effects of stimulants. In September 2006 the agency held hearings on the subject and decided not to "scare" parents by putting a black box warning in the label concerning either cardiovascular or psychiatric side effects. In February 2007 the FDA issued a news release announcing its intentions to warn about the risk of cardiovascular adverse events including sudden death in patients with underlying serious heart problems or defects and stroke and heart attack in adults with unspecified risk factors. It then went on to minimize findings of psychiatric adverse events, citing "a slight increased risk (about 1 per 1,000) for drug-related psychiatric adverse events, such as hearing voices, becoming suspicious for no reason, or becoming manic, even in patients who did not have previous psychiatric problems". The cited rate of one event per 1,000 is unconscionably small. One retrospective review of clinic records, for example, found that nearly 10 percent of children, or 100 per 1,000, developed signs of psychosis including cases of "paranoia", "visual hallucinations", and "auditory hallucinations, aggressive, agitated behavior" (Cherland and Fitzpatrick, 1999 [87]).
Why do so many people take such harmful drugs? Why do they persist in taking them long after the drugs have begun to do more harm than good?
The persistent use of harmful drugs is not limited to psychiatric drugs. People frequently abuse non-prescription drugs such as alcohol and marijuana despite their obviously harmful mental and emotional effects. In the extreme, alcoholics ruin their lives and the lives of their families as they drink themselves to death. Alcohol, of course, causes dependence (the new name for addiction). But even in the absence of addiction, people often take drugs to their obvious personal detriment and frequently to the detriment of others as well.
Over the years I have evaluated many dozens of clinical and legal cases in which individuals have endured severe and sometimes lasting mental impairment from taking psychiatric drugs. In many of these cases, the individuals committed horrendous acts that were wholly out of character for them. Recently when re-evaluating my extensive experience with these cases, I realized that all psychoactive drugs produce an effect that can be called medication spellbinding or, more technically intoxication anosognosia (Breggin, 2006e [74]). Anosognosia means the inability to recognize illness in oneself. Drugs that impair mental function at the same time impair the individual's ability to recognize that dysfunction.
All psychoactive drugs - that is, all drugs that affect the brain and mind - tend hide or to mask their harmful mental effects from the individuals who use them. Often these drugs make spellbound individuals feel that they are mentally improved when they are in reality mentally - impaired. In extreme drug spellbinding, they compel people toward thoughts and actions such as violence and suicide that they would ordinarily find appalling.
Every class of psychiatric drugs - antidepressants, stimulants, tranquilizers, mood stabilizers, and antipsychotics - causes mental impairments that often go unrecognized by the victim, even when they are severe (The drugs in these categories are listed in the Appendix). This misleads medicated patients into believing that they are doing better even when they are getting worse. As a result, people often feel they cannot live without psychiatric drugs when a careful history reveals that their lives have deteriorated during the time they have been exposed to them.
Antidepressants, stimulants and tranquilizers (especially Xanax) frequently cause unrecognized over-stimulation that can lead to acts of aggression or suicide. Mood stabilizers like lithium and antipsychotic drugs like Zyprexa, Risperdal, Seroquel, and Geodon often lead to a flattening of emotions that the patient and doctor alike overlook or mistake for clinical depression. The concept of medication spellbinding helps to explain how adverse reactions go unrecognized or unappreciated, and why so many people feel compelled to take so many drugs that cause them mental impairment. The concept of medication spellbinding clarifies the destructive compulsion to persist in taking harmful drugs. The subject of spellbinding will be expanded and documented with dozens of cases in my forthcoming book, Medication Madness: True Stories of Mayhem, Murder and Suicide Caused Psychiatric Drugs.
In conclusion, a great deal has happened in the past eight years that confirms our concerns and warnings expressed in first edition of this book. The reader can be reassured that the observations made in this book are based on sound scientific data, even if some of these observations remain ahead of their time.
The first edition of "Your Drug May Be Your Problem" appeared at the height of a period of "biopsychiatric hubris" - the excessive pride and arrogance linked to the view that people who suffer emotionally or misbehave have defective brains and genes and should take psychiatric drugs.
It seemed to me then that this viewpoint resembled a cult. It was impervious to reason or evidence, hostile to counter-arguments, and locked its adherents in a strange chemical embrace. At the time, to argue that prolonged psychotropic drug use had no scientific justifications and was potentially very dangerous, and to suggest how to stop taking drugs, went so straight against conventional thinking and practice that it could have seemed foolhardy.
In the intervening eight years, however, the basic arguments set out in this book have been shown to be prescient, well founded, and useful to patients and clinicians alike. This may have occurred partly because of the following:
Let me discuss briefly some of these changes and what they could mean for you as a consumer or potential consumer of psychiatric drugs, or as someone contemplating coming off psychiatric drugs.
When we drafted "Your Drug May Be Your Problem" back in 1998, the Internet helped us mostly to search for bibliographic sources and to peruse a few hundred postings from individuals discussing their withdrawal reactions online. However, when I typed "antidepressant withdrawal" on a popular Web search engine while writing this introduction in early 2007, the startling result was 1.2 million hits. The few listings I consulted offered general advice from professionals and laypersons on discontinuing drugs, how-to-taper strategies, users, daily withdrawal logs, summaries of published case reports, ways to cut pills or divide capsules, advertisements for antidepressants or for "herbal detoxification" products, legal briefs, online discussions between consumers, as well as other varied material including some extremely sophisticated analyses of drug effects from laypersons. Of course, just like information about drugs from experts, information on the Internet must be evaluated critically, and we offer in Chapter 7 some guidelines to assess the quality of Web sites offering withdrawal-related advice.
To me, however, this content illustrates how the creation of knowledge about psychiatric drugs has moved and will continue to move far beyond the traditional confines set by credentialed experts. Withdrawal reactions and dependence on antidepressants did not emerge from observations by experts. Rather, experts could no longer ignore these problems when they were described without intermediary by tens of thousands of patients.
How extensively the pharmaceutical industry shapes medical and psychiatric research and practice and how it thwarts drug regulation to the industry's advantage has now become a mainstream topic of study.
In its relentless pursuit of profits, the drug industry uses every means at its disposal to shape how people think about disease, health, and treatment. This means, notably, that it carefully orchestrates the production of infomercials that are passed off to policymakers, clinicians, and consumers as scientific studies, to the detriment of patients' health and of the integrity of scientific research.
In 2004 and 2005 alone, the following titles, among others, documented this depressing reality in detail; "The Truth About the Drug Companies: How They Deceive Us and What to Do About It", by Marcia Angell [11], former editor-in-chief of the New England Journal of Medicine and a professor at Harvard Medical School; "On the Take: How Medicine's Complicity with Big Business Can Endanger Your Health", by Jerome Kassirer [221], also a former editor-in-chief of the New England Journal of Medicine and professor at the Tufts University School of Medicine; "Let Them Eat Prozac: The Unhealthy Relationship Between the Pharmaceutical Industry and Depression", by David Healy [199], psychopharmacologist and historian of psychiatry; "Selling Sickness: How the World's Biggest Pharmaceutical Companies Are Turning Us All Into Patients", by medical journalists Ray Moynihan and Alan Cassels; "Medicines Out of Control? Antidepressants and the Conspiracy of Goodwill", by Charles Medawar, founder of the U.K. organization Social Audit, and Professor Anita Hardon; "Overdo$ed America: The Broken Promise of American Medicine", by John Abramson [1], clinical instructor at Harvard Medical School; "The $800 Million-Dollar Pill: The Truth About the Cost of New Drugs", by Merrill Goozner [183], journalist; and "Generation Rx: How Prescription Drugs are Altering American Lives, Minds, and Bodies", by Greg Critser [124], author and journalist.
If I had to choose one take-home message to extract from the sum of these compelling works, it's the following: The personal, individual choices that both you and your doctor make with respect to your treatment for emotional distress are, more often than not, simply the end result of well-organized marketing campaigns by the industry to sell its products.
Despite the decades-long barrage of reports of industry-funded clinical trials presumably demonstrating the superiority and safety of psychiatric drugs, the National Institute of Mental Health (NIMH) was prompted to support, at a combined cost of $100 million, three large studies to test the latest drug treatments for the major psychiatric disorders.
The studies were unusual in that they enrolled several thousand patients, most of whom would have been excluded from most short-term clinical trials. Under more "real-world" treatment conditions and using more real-world outcomes than those from conventional clinical trials, many of these patients were followed for more than a year. Main findings from the studies began appearing in late 2005 and continue as of this writing.
The Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) project recruited nearly 1,500 individuals diagnosed with schizophrenia and randomly assigned them to receive one of five different antipsychotic drugs (four newer "atypical" drugs, Zyprexa, Risperdal, Seroquel, Abilify, and one old antipsychotic rarely used today Trilafon). After eighteen months, across the five groups, between 64 percent and 82 percent of patients had quit their treatment because of "intolerable side effects or lack of efficacy or other reasons" (Lieberman et al., 2005 [256]). Most observers were taken by surprise, having accepted as scientific facts the drug industry's promotional messages that atypical antipsychotics were basically magic potions. I wasn't surprised, having shown earlier how studies of the atypical antipsychotics were so rigged with systematic biases and manipulations that few of their claims could stand critical scrutiny (Cohen, 2002 [97]).
The Sequenced Treatment Alternatives to Relieve Depression (STAR*D) project recruited nearly 2,900 patients diagnosed with nonpsychotic major depression and subjected them to what modern psychiatry considers to be the best treatment for depression. In the first sequence, all these patients were treated with the SSRI antidepressant Celexa. Their doctors could tailor doses individually based on patients' feedback and, on average, each patient was medicated for about twelve weeks. The result: less than 30 percent had a remission of symptoms during the entire study period (20 months) (Trivedi et al., 2006 [373]). The study continued, with different medication strategies - such as augmentation with other antidepressants or switching to other antidepressants - applied as the pool of subjects who did not drop out got smaller and smaller. In one particular sequence, among 727 people initially medicated with Celexa with no success and then agreeing to take either Wellbutrin, Zoloft, or Effexor for up to fourteen weeks, an average of only 21 percent experienced a remission - less than the percentage of those who dropped out because of intolerable side effects (23 percent). And more than half of all participants reported that they experienced moderate to severe side effects more than half of the time (Rush et al., 2006 [326]).
Finally results of the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD), described as the largest treatment study of bipolar disorder ever performed, also appeared recently. The study claimed to use a "best-treatment-available" approach (mostly anticonvulsants, antipsychotics, lithium, and benzodiazepines), and as in the other treatment studies just described, recruited a broadly representative sample of almost 1,500 patients from across the country who underwent a full two years of treatment. The results: only 28 percent of treated individuals achieved full remission and experienced no recurrence during the two years (Perlis et al., 2006 [304]).
Keep in mind that there were no placebo-treated groups in these three studies. Conservatively one could estimate that at least half of subjects who responded to the drugs would have responded to placebos - which would have revealed "net" desired drug effects as even less impressive. Keep in mind also that subjects in all studies might have received several medications. In the STAR*D study for example, in addition to Celexa, additional drugs to counteract sleep, anxiety, and agitation problems, as well as Celexa - induced sexual dysfunction, were given at physicians' discretion.
It remains to be seen just how doctors seeking to obtain informed consent from their patients to receive psychiatric drugs for depression, psychosis, or bipolar disorder will discuss these latest findings with their patients. Commenting on the CATIE findings, the lead investigator candidly admitted that:
"The claims of superiority for the [newer antipsychotics] were greatly exaggerated. This may have been encouraged by an overly expectant community of clinicians and patients eager to believe in the power of new medications. At the same time, the aggressive marketing of these drugs may have contributed to this enhanced perception of their effectiveness in the absence of empirical information" (Lieberman, 2006 [255]).
Disseminating greatly exaggerated claims of superiority in the absence of empirical information - is this science, or propaganda?
Many practitioners, recognizing that results from these major treatment studies directly challenge practice-as-usual, suggest that the best guideline still remains to "use medication wisely". But, as this book argues, this is not so simple as it might sound. It's difficult to find a doctor admitting that he or she does not prescribe medication wisely yet it's disconcertingly easy to identify harmful, scientifically unsupported, involuntarily imposed, or plainly excessive psychotropic drug prescription practices.
In one recent case in which I reviewed medical records, a ten-year-old child in the middle of a custody dispute was receiving, from the same doctor, six psychotropic drugs simultaneously belonging to five different drug classes. Over the past few years, the child has been placed on and withdrawn from over fifteen different drugs. The case notes and discharge summaries were filled with descriptions of behaviors that might reasonably be attributed to the mental confusion and emotional and physical roller coaster to which this unbelievably irrational drug cocktail was probably subjecting the child. Yet neither the child's doctors, nor the judge overseeing the case, nor an experienced clinical psychologist appointed by the court to make recommendations, voiced that anything might be wrong with this picture.
The bigger picture includes the following: The number of antipsychotic prescriptions to children two to eighteen years increased from under 500,000 in 1995-1996 to almost 2.5 million in 2001-2002 (Cooper et al., 2006 [121]). Most of these prescriptions were for indications for which antipsychotics have not been studied in children. Even more dramatic trends are being reported about the prescription of anticonvulsants to youths (Blader and Carlson, 2007 [39]). Yet the psychiatric journals reporting these findings merely call for more well-controlled studies of antipsychotics or anticonvulsants in children.
Arguably, "better" evidence is not likely to slow this engine running out of control. The absence of evidence did not prevent doctors (not only psychiatrists but pediatricians, family medicine physicians, emergency department physicians, and other types of providers) from experimenting with antipsychotics and anticonvulsants. It is difficult to see how any self-corrective mechanisms might come into play to bring sanity back to caring for children in distress.
In sum, now more than probably any time before, I believe that most people are able to avail themselves of better quality, unbiased information and critical perspectives to help them decide whether, when, and for how long to take psychiatric medications, and how to safely come off them.
However, the playing field remains quite uneven, with most consumers and even clinicians deeply in the dark about the common pitfalls of using psychiatric drugs, with increasing numbers of children subjected to the most powerful and harmful drugs, and with most sources of information on drugs still controlled by the drug industry and vested medical interests.
We are gratified by the response from readers of the first edition of "Your Drug May Be Your Problem", and we are hopeful that this second edition will continue to meet their needs and answer their questions.
This book is filled with technical and scientific information about psychiatric drugs (especially their dangers) and how to withdraw from them. However, it is also important to understand the underlying psychological, social, and ethical principles that may affect your decision to use or not use psychiatric drugs.
We can learn a great deal about ourselves and how we view life by asking, "Where do we turn when we feel emotionally upset or despairing? Where do we go when life seems unendurable and we have little or no hope left? What are our ultimate resources in life - the places and persons to whom we turn for help, direction, and inspiration?"
All people seem to need faith, but the varieties of faith seem infinite. For many individuals, the ultimate resort or resource is religious or spiritual: God and prayer, or other beliefs and practices, and perhaps a trusted minister, priest, rabbi, or counselor. For others, the ultimate resort may be a loved one - a husband or wife, a parent, a friend. Still others may believe that they themselves are the ultimate resource. They may turn to creative work, nature, pets, hobbies, sports, or some other more seemingly individual or personal pursuit. Increasingly, people nowadays also turn to science to find answers about how to live life. Probably for most people, the final resort is a combination of these resources: God, nature, science, other people, and oneself. Ultimately, all human resources are related. Commitment to a loving, zestful, rational, principled life becomes the cornerstone of life and the final resource.
Many people, however, rely on another, more limited resource when they face psychological or social crises. They turn to psychoactive or mind-altering substances. Although they may believe or hope that they are relying on seemingly objective science, in reality they are placing their faith in drug company marketing - and so are their doctors.
Consider the seemingly different situation with respect to recreational or illicit drugs. For untold millions throughout the world, the last resort is alcohol, tobacco, or substances such as marijuana and cocaine. Many turn to them whenever they feel on the verge of experiencing painful emotions. In the extreme, they become addicted to these substances and build their lives around them. When they eventually try to give up their addiction, they may discover that they have no other resources left and nowhere else to turn. Their lives have been emptied by their reliance on drugs. They must rebuild from scratch their faith in God or other ethical convictions, their trust in other people, and their reliance on themselves and their love of creative work or nature.
If people do feel better when drinking alcohol or smoking marijuana, it is because they feel better when their brain is impaired. Psychiatric drugs are no different. The people who take such drugs may feel less of their emotional suffering. They may even reach a state of relative anesthesia. But to the degree that they feel better, it is because they are experiencing intoxication with the drugs.
Most of us can empathize with people who are willing to sacrifice brain function in return for a blunting of emotional suffering, but should therapists or doctors offer this alternative? Should we ourselves turn to this alternative in our own lives? Is the cost too great in terms of brain dysfunction and the failure to deal with the real issues in our lives?
The resort to psychoactive substances, whether legal or illegal, recreational or psychiatric, involves a compulsive narrowing of focus in the search for solutions to life's problems. Almost always the emphasis is on obtaining relief from painful emotions, too often regardless of the potential cost.
Emotional suffering is inevitable in life. But it has a meaning - a purpose, Suffering is a signal that life matters. Specifically it is usually a signal that something in our lives that matters a great deal needs to be addressed. Depression, guilt, anxiety, shame, chronic anger, emotional numbing - all of these reactions signal that something is amiss and requires special attention. The depth of suffering is a sign of the soul's desire for a better, more creative, more principled life.
For example, when faced with a patient in deep depression, should we immediately focus on relief of the pain? On the contrary, we should respond by saying that the pain is a signal of the intensity of the person's spirit: "The strength and intensity of your suffering indicates the strength and intensity of your spirit. Your discomfort shows how alive you are. Now imagine if you could learn to turn all that self-destructive energy into creative energy and a love of life".
The degree to which we suffer indicates the degree to which we are alive. When we take drugs to ease our suffering, we stifle our psychological and spiritual life. Instead, we need to find a way to untangle that twisted energy and to redirect it more creatively. Sometimes this process of personal and psychological growth can be helped by insightful psychotherapy or other therapeutic and educational techniques - including those that facilitate our understanding of early childhood sources of the suffering. At other times, the process is helped by our understanding of the problems in our immediate lives, such as an unhappy marriage, a frustrating job, or a difficult financial situation. Sometimes this understanding involves learning new principles of living with which to guide ourselves more effectively which, in turn, may entail a recommitment or a new commitment to spiritual or philosophical ideas, and especially love for ourselves, for other people, and for life or some other guiding ideal. Sometimes it involves a therapist who cares so much about the client that the client can begin to care about himself or herself.
The last ten to twenty years have seen a drastic change in viewpoint regarding the ultimate resource of moral and psychological guidance: Regardless of their religion or philosophy, many educated and informed people have come to believe that psychiatry and psychiatric drugs provide the best last resort for themselves when in psychological distress. Indeed, such drugs are increasingly the first resort. It appears that we have replaced reliance on God, other people, and ourselves with reliance on medical doctors and psychiatric drugs. The ultimate source of guidance and inspiration is no longer life itself with its infinite resources but biopsychiatry with its narrow view of human nature.
This view of ourselves is a most astonishing one. It suggests that most if not all of our psychological, emotional, and spiritual problems are "psychiatric disorders" best treated by specialists who prescribe psychoactive drugs. Our emotional and spiritual problems are not only seen as psychiatric disorders, they are declared to be biological and genetic in origin.
The propaganda for this remarkable perspective is financed by drug companies and spread by the media, by organized psychiatry and individual doctors, by "consumer" lobbies, and even by government agencies such as the National Institute of Mental Health (NIMH). As a result, many educated Americans take for granted that "science" and "research" have shown that emotional upsets or "behavior problems" have biological and genetic causes and require psychiatric drugs. Indeed, they believe they are "informed" about scientific research. Few if any people realize that they are being subjected to one of the most successful public relations campaigns in history.
These days, your doctor is likely to suggest medication for relatively mild degrees of emotional upset or distress: even a few weeks of moderate sadness or anxiety are apt to lead to a prescription. If your child has been difficult to deal with for a few weeks at home or in school, that, too, is likely to bring out the prescription pad. The problem may have lasted for only a short period, but the drug treatment may go on for years or even for a lifetime.
Psychiatric diagnosis has become so widespread that it is almost impossible to mention any kind of "feeling" to a medical doctor without being assigned a psychiatric label and prescribed the latest psychiatric drug. And this scenario is not limited to strong emotions or serious distress. Feeling fatigued? Take Prozac. Feeling as though you've lost your enthusiasm or direction? Take Paxil or Zoloft, especially if Prozac hasn't worked. Feeling trapped in an abusive relationship? Take Effexor, Luvox, or lithium. Feeling a little nervous? Take Xanax, Klonopin, or Ativan. Having trouble disciplining your child? Give the child Ritalin, or Dexedrine, or Adderall. Having trouble focusing on work that bores you? Try Ritalin for yourself. Haying ups and downs of any kind? Take any number of psychiatric drugs.
Do we know what we are doing to our brains and minds when we take psychiatric drugs? Do we know what we are doing to our children when we give them these substances?
Consider this extraordinary reality. The human brain has more individual cells (neurons) than there are stars in the sky: Billions! And each neuron may have 10,000 or more connections (synapses) to other brain cells, creating a network with trillions of interconnections. In fact, the brain is considered to be the most complex organ in the entire universe. With its billions of neurons and trillions of synapses, it is more complex than the entire physical universe of planets, stars, and galaxies.
Scientists have well-developed ideas about how the physical universe works. They possess mathematical formula for describing the various forces that control the relationships among physical entities from black holes to subatomic particles. All these forces also affect the human brain. However, the living processes of the brain add complexities unknown in the physical universe. Those trillions of interconnections between brain cells, for example, are mediated by hundreds of chemical messengers (neurotransmitters), as well as by hormones, proteins, tiny ions such as sodium and potassium, and other substances. We have limited knowledge about how a few of these chemical messengers work but little or no idea as to how they combine to produce brain function.
The public is told that a great deal of science is involved in the prescription of psychiatric drugs, but this is not so - given that we know so little about how the brain works. The knowledge that we do have about the effects of psychiatric drugs on the brain is largely limited to test-tube studies of biochemical reactions utilizing ground-up pieces of animal brain. We simply do not understand the overall impact of drugs on the brain.
Nor do we have a clear idea about the relationship between brain function and mental phenomena such as "moods" or "emotions" like depression or anxiety. We don't even know where to begin looking because we don't fully understand how the brain functions.
Some theoreticians would urge us to focus on the molecular level by looking for biochemical imbalances. But that's sheer speculation. Why would a biochemical imbalance be at the root of feeling very depressed any more than it would be at the root of feeling very happy? And if there were biochemical substrates for extreme sadness and extreme happiness, would that fact make them diseases? The idea of individual biochemical imbalances is wholly at odds with the complexity of the brain.
Besides, whose biochemical imbalance are we looking for? That of the child who is out of control or the caregiver who has difficulty disciplining? That of the child who isn't learning or the teacher who hasn't figured out how to reach this child? That of the individual who becomes anxious in dealing with people or the adult who abused the individual as a child? That of the person who is deeply depressed over a lost loved one or the doctor who recommends electroshock? That of the person who feels insecure or anxious or the doctor who thinks that the person's problems require drugs? In short, whose brain isn't working right?
As one of our colleagues recently said, "Biochemical imbalances are the only diseases spread by word of mouth". Individually we must all use our own intuitive understanding of life to determine the likelihood that our problems are caused by some as-yet-undetected brain dysfunction rather than by conflicts in the home, at work, or in society, painful life experiences, confused values, a lack of direction, or other aspects of human life.
Of course, our bodies can affect our emotional outlook. We all find it much easier to maintain a bright and enthusiastic attitude when physically healthy than when physically ill. And anything from lack of sleep to the common cold can affect our moods.
However, doctors commonly give people psychiatric drugs without checking for obvious signs of serious physical disorder, such as hypothyroidism, estrogen deficiency or head injury from a car accident. Moreover, they seem particularly prone to overlooking the importance of physical symptoms in women. Some women with obvious signs of a hormonal disorder or heart condition are put on antidepressants and antianxiety drugs without first being required by their internists or psychiatrists to undergo a physical evaluation.
It is therefore theoretically possible that some anxious or depressed people may be afflicted with an as-yet-undetected physical dysfunction. But this speculation doesn't justify the unfounded conclusion that people in emotional distress are beset by specific biochemical imbalances or that such imbalances can be corrected with drugs.
In our own experience, most people with depression and anxiety have obvious reasons for how they feel. These reasons are often apparent in their everyday lives and may be complicated by past experiences in childhood or earlier adult life. But even if some people do turn out to have subtle, undetected biochemical imbalances, there is no reason to give them drugs like Prozac or Xanax that cause biochemical imbalances and disrupt brain function.
Let us again consider the final resort. Is it defined by our values, our family and friends, and ourselves - or by a medical doctor with a prescription pad?
Almost all psychiatric drug research is done on the normal brains of animals, usually rats. As noted earlier, much of this research involves grinding up brain tissues to investigate the gross effects of a drug on one or more limited biochemical reactions in the brain. More sophisticated research involves micro-instrumentation that injects small amounts of drugs into the living brain and measures the firing of brain cells. Yet even these more refined methods are gross compared to the actual molecular activity in the brain. For example, we have no techniques for measuring the actual levels of neurotransmitters in the synapses between the cells. Thus all the talk about biochemical imbalances is pure guesswork. More important, what's actually being studied is the disruption of normal processes by the intrusion of foreign substances.
This research in no way bolsters the idea that psychiatric drugs correct imbalances. Rather, it shows that psychiatric drugs create imbalances. In modern psychiatric treatment, we take the single most complicated known creation in the universe - the human brain - and pour drugs into it in the hope of "improving" its function when in reality we are disrupting its function.
The notion that Prozac corrects biochemical imbalances is sheer speculation - propaganda from the biological psychiatric industry. But disruption of biochemical reactions in the brain, causing severe biochemical imbalances and abnormal rates of firing among brain cells, is a proven fact about Prozac that cannot honestly be disputed by anyone who knows the research.
How does the brain react to the intrusion of psychiatric drugs such as Prozac, Ritalin, or Xanax?
The brain reacts as if it is being invaded by toxic substances: it tries to overcome, or compensate for, the harmful drug effects. In the process, the brain literally destroys its own capacity to respond to the drug. It numbs itself to the drug and, in so doing, actually kills some of its own functions. So when a doctor tells us that Prozac is putting our biochemicals into balance, we are being badly misled. In actuality Prozac is profoundly disrupting the function of the brain.
Prozac, Ritalin, and Xanax, like most psychiatric drugs, overstimulate particular neurotransmitter systems either by increasing the output of a neurotransmitter or by preventing its removal from the synapses between nerve cells. Prozac, for example, overstimulates a chemical messenger called serotonin by blocking its removal from the synapse. The brain reacts initially by shutting down the release of serotonin and then by reducing the number of receptors that can respond to the serotonin.
These self-destructive processes in the brain are relatively easy to research. They were demonstrated in the private laboratories of Eli Lilly - the manufacturer of Prozac - even before the drug was approved for marketing by the Food and Drug Administration (FDA). Long before the marketing of Prozac, the drug was known to routinely cause drastic biochemical imbalances rather than to correct them.
How long does it take the brain to recover from the imbalances caused by Prozac? We don't have an answer to this critical question. Why not? Because drug companies and the scientific community have never carried out the relatively simple and inexpensive research that would be required. Yet we should suspect that the brain does not always recover from Prozac or similar antidepressants such as Paxil and Zoloft.
We already know that the brain's recovery from exposure to many psychiatric drugs can be prolonged and that full recovery may never take place. Studies have demonstrated this outcome for stimulant drugs such as the amphetamines, including Dexedrine and Adderall, that are prescribed for children. Although the final verdict concerning Ritalin isn't in, its similarity to the other stimulants is such that we should be concerned about its capacity to cause irreversible changes. We also know that irreversible changes can occur in response to the drugs used to treat schizophrenia, such as Haldol, Prolixin, and Risperdal. These drugs can cause permanent, severe impairments of brain function, indeed, we should suspect that any psychoactive drug-any drug that affects mental function-tends to produce irreversible changes in some if not most people.
What hope can we have that bathing the brain in a psychiatric drug will actually improve the overall function of this mysterious organ? Almost none. In fact, as already noted, most of what we know about the various neurotransmitters has been gathered by studying how psychiatric drugs disrupt or spoil their functioning.
Imagine what would happen if we treated our much simpler computers in the same way as we treat the brain in psychiatry. Consider the case of a computer that is "crashing" too often. With considerable poetic license, we can compare this mechanical dysfunction to the human tendency to become "overwhelmed" or "overloaded" with depression, anxiety or obsessions and compulsions, and unable to function easily in everyday life.
Perhaps the computer is crashing for reasons having to do with its hardware. For example, the computer may need more memory or a new hard drive. Alternatively the problem may be traceable to its software - to one or more of the programs installed in the computer. Then again, the operator of the computer and its programs may be responsible. Or the source of the problem could lie outside the computer and even outside the office, as in the case of power surges.
When troubleshooting such a problem, computer experts routinely take all of these factors into consideration - the computer, the program, the operator, and the power source. If the cause of the problem isn't immediately apparent, they may run experimental tests or programs in order to diagnose the problem.
The approach taken by psychiatrists and other medical doctors, by contrast, is both simple-minded and destructive. In contemporary psychiatry the doctor almost always assumes that the problem lies in the "hardware" of the brain (i.e., in "biochemical imbalances"). In the words of one well-known psychiatrist, emotional and behavioral difficulties are caused by a "broken brain".
Modern psychiatrists seem to consider themselves brain consultants, but they have little knowledge with which to establish that expertise. Unlike computer consultants, psychiatrists have no way of identifying or locating the source of the problem in a patients brain. So the patient must take their "expert" assertions on faith.
How would you react if your computer consultant treated your computer the way psychiatrists treat patients and their brains? Suppose your consultant invariably concluded that the problem must lie in the hardware of your machine rather than in the program, the operator, or some external factor such as the power source. Suppose your consultant always began by pouring toxic agents into your computer. Further suppose that your consultant never guaranteed you a good result while continuing to pour toxic agents into your machine without regard for the consequences - and, when pressed for an explanation, made vague references to "crossed wires" or "electrical imbalances" in your computer but never looked inside, conducted any tests, or provided a definitive physical diagnosis.
How long would you put up with such nonsense from your computer consultant? Not very long. If computer consultants behaved like psychiatrists, we would fire them. Yet, tens of millions of people put up with even more slipshod, irrational treatments involving their far more complex and vulnerable brains and minds.
What happens when we start viewing a human being as an object? We lose our own capacity for rationality and for love. It is impossible to reduce a person's emotional suffering to biochemical aberrations without doing something psychologically and morally destructive to that person. We reduce the reality of that individuals life to a narrowly focused speculation about brain chemistry.
In taking such a distorted view of the person, doctors also do harm to themselves. They suppress their natural tendency to be empathic toward other human beings. Thus, in their efforts to be "objective" and "scientific", biological psychiatrists and doctors end up doing very destructive things to people, including themselves.
Although this book is about psychiatric medications that are approved by the FDA, many readers may have questions about psychoactive herbal remedies that can be obtained over the counter (OTC). They may wonder if these more "natural" substances can be used instead of psychiatric drugs during the withdrawal process or as a general substitute. In brief, we do not recommend the use of psychoactive herbs for these purposes.
Many people believe that such natural remedies are likely to be safer than prescription drugs. This is the implication conveyed by many books that evaluate herbal medicines, such as PDR for Herbal Medicines (1998) [300] and Alternative Medicine (1994). Both list far fewer adverse effects for typical herbal remedies (such as St. John's Wort as an antidepressant or ginseng as a stimulant) than are usually described in the literature for psychiatric drugs used for corresponding purposes (such as Prozac or Ritalin).
Nonetheless, anyone who uses psychoactive herbs should do so with caution. Some of these herbs have recognized adverse effects. For example, ginseng, in large doses, can cause dependence with serious adverse effects. The scientific citations typically listed for herbs are mainly non-English language reports not readily accessible to the ordinary reader in the United States. The composition of many of these substances, including St. John's Wort and ginseng, is very complex, with numerous active agents that have been little studied. Preparations from different manufacturers - or even from the same manufacturer - may not be standardized. And, finally even though the FDA often fails to live up to its mandate, FDA-approved drugs are usually more thoroughly studied than herbal remedies in regard to adverse effects.
Some people might believe that a long history of use without known ill effects is in itself a good indication of a psychoactive herb's safety. However, consider two of the most widely used natural psychoactive substances, alcohol and tobacco: Both were once recommended by physicians for medicinal purposes, and both have been heavily promoted by government and corporate interests. Alcohol has been used for many reasons by untold millions of human beings since before recorded history but only in the last few decades have the harmful effects of chronic excessive alcohol use been generally recognized. Society has also become increasingly aware of the association between acute alcohol use and many forms of violence and accidents. Likewise, tobacco has an ancient history of ritual use in Native American societies and, in more recent centuries, of widespread chronic use in Western society. But the dangerousness of smoking did not gain widespread recognition until a few decades ago.
Any drug that affects the brain and mind should be viewed with caution, especially in the context of daily or persistent use. And any person who decides to use herbal remedies should read as much as possible about them. To use these agents is, to some extent, to step into the unknown. By contrast, all psychiatric drugs have well-documented, serious hazards.
Even if psychoactive substances were harmless, we would question their use for "therapeutic" or "psychiatric" purposes - that is, to overcome psychological and social problems. The use of a psychoactive substance for such purposes is wrong in principle because it represents an attempt to fix the brain instead of the problems that lie within the person's internal life, relationships, and environment.
It is understandable, of course, that people want relief from emotional suffering, just as they tend to take aspirin, ibuprofen, or other drugs for head, muscle, and joint pains. The latter treatments play a valuable role, especially if they are administered over the short term. However, both aspirin and ibuprofen also have many potentially serious adverse effects, ranging from stomach ulcers to stroke.
The use of "emotional painkillers" is more questionable. If a person gets headaches because of the stress of a conflicted marriage or a frustrating workplace, it would ultimately be self-defeating to rely on pills instead of dealing with the issues involved. Besides, all psychiatric drugs have far more negative effects on brain and mind function than do aspirin or ibuprofen. Psychiatric medications are, first and foremost, psychoactive or psychotropic drugs: They influence the way a person feels, thinks, and acts. Like cocaine and heroin, they change the emotional response capacity of the brain. If used to solve emotional problems, they end up shoving those problems under the rug of drug intoxication while creating additional drug-induced problems.
There is another lesson to be gained from how long it has taken us to recognize the dangers of tobacco and alcohol. Because it has taken centuries to grasp the damaging effects of these natural substances on individuals, families, and society we cannot blithely assume that we can learn about the dangers of psychiatric drugs in a matter of months or years.
Many drugs are effective in bringing about the short-term relief of emotional suffering. Alcohol, for example, affects the same general neurotransmitter system as tranquilizers like Xanax, Valium, Klonopin, and Ativan. It has similar clinical effects, too. Millions of people "take a drink" to relax or calm down, to relieve anxiety or even depression, and to fall asleep more easily. Yet alcohol, much like the tranquilizers, has many negative effects on behavior, tends to worsen the very problems it is used to treat, and can become addictive.
The question, then, is not "Do drugs affect mental processes?" Many drugs are called "psychoactive" precisely because they have effects on the mind. Rather, the question is. "Should they be prescribed as treatments?"
This book is aimed at helping people understand some of the medical and psychological dangers of relying on psychiatric drugs, but it can only hint at the psychological and social void created by such reliance on mind-altering agents. The book also offers approaches to coming off psychiatric drugs, but, in this context too, it can only hint at the kinds of resources to which people must turn to live a meaningful and satisfying life. The choice is not between psychiatric drugs and some other "therapy" but between psychiatric drugs and all the resources that life can offer us.