Open letter to the Government, to powerful corporate classes that have a dominant influence in health care delivery, big business, health insurers, the pharmaceutical industry, governments and insurance companies, all of which determine who health care was to be delivered to, and what form it should take:
YOU HAVE COLLECTIVELY CAUSED A PUBLIC HEALTH DISASTER FROM WHICH THE DISCIPLINE OF PSYCHIATRY MIGHT NEVER RECOVER
Dear Health Ministers, State and Federal;
Dear Finance Ministers, who should be more interested in wasted money and wasted lives;
Dear Consultants to Mental Health services who try to fix the problems, while ignoring the elephant in the room which is:
The drugs that do more harm than good.
According to the research done by the Cochrane Collaboration.
The Crisis in Mental Health demands endless resources yet fails to improve outcomes.
The demand for care does not represent an increase in the incidence of mental illness.
It is an epidemic of known, listed, yet unrecognized side effects of medicines given, unmonitored, to a large population. Whitaker asks:
Since this epidemic has unfolded in lockstep with the ever-increasing use of psychiatric drugs, an obvious question arises: Is our drug-based paradigm of care fueling this modem-day plague?
The situation can be understood at an individual and epidemiological level by attending drug efficacy issues, drug metabolism and drug side effects.
This comment describes how misdiagnosis happens, both generally and in specific cases.
By 2011 we had tested 85 persons on drugs metabolised by CYP450. We have now tested over 200 persons for metabolizing genes of the CYP450 family; 2D6, 2C9 and 2C19.
The criterion for testing was that they had developed akathisia with suicidality only after medication with psychiatric drugs, and many developed side effects that were mistaken for mental illness.
Only three had normal wild type genes, and they were on high doses, or two or more drugs.
60% of those tested spent more than a year on medicines, 10% spent more than ten years as mental health patients and 20% are still on drugs as their treaters are not responsive to pharmacogenetic information, or to fraudulent marketing, proved in courts about the frauds underpinning the information on which they base their prescribing.
This is the population described here:
The most common entry point into the ranks of these newly created “mentally ill” was through the prescription of an antidepressant (about 65% in our series) to a patient for anxiety or a trivial reason, for anxiety or common distress and definitely not for biological depression, which is the only condition known to respond to chemical therapies.
A “standard” dose is prescribed to a person who, unbeknown to the prescriber, carries a genetic mutation associated with slow metabolism.
Such a person will develop high, toxic blood levels and some of the side effects of the antidepressant which are listed in product information on the website of US FDA:
But this is what TGA circulates:
The US product information for Efexor contains 81 pages, in contrast to the 33 pages provided on the TGA's website.
Side effects include, but are not limited to, worsening depression, suicidal ideation; suicide attempt, amnesia, confusion, depersonalization, hypoesthesia, thinking abnormal akathisia, apathy, emotional lability, euphoria, hallucinations, hostility, manic reaction, (manic switch), psychosis, abnormal speech, abnormal/changed behavior, adjustment disorder, alcohol abuse, feeling drunk, delusions, dementia, homicidal ideation, hysteria, impulse control difficulties, neuritis, paranoid reaction, psychotic and worsening or new depression.
Neither the drug company representatives who flood doctors with samples nor Clinical Practice Guidelines, nor Pharma funded education makes any mention of catastrophic side effects:
However if catastrophic side effects do occur, the person with diminished CYP450 metabolism becomes hallucinated, euphoric, deluded or otherwise psychotic, akathisic, cognitively impaired, suicidal or violent even on a standard dose.
With no regard to extensive lists of the first drug’s side effects, an antipsychotic is added, and nearly every antipsychotic requires the same CYP450 metabolic pathway, which should be suspected of being impaired.
Sometimes worsening, or new depression elicits an increase in the dose of antidepressants or added mood stabilisers, which further interfere with metabolism.
The resulting condition, with an unpredictable mix of the symptoms described above is eventually designated ‘’treatment refractory” schizophrenia, that diagnosis alternating with mania, delusional disorder, schizoaffective disorder and sometimes major depression.
Sometimes organic personality disorder looks like borderline personality disorder if suicide attempts and impulsivity are prominent, but the borderline personality disorder diagnosis should be excluded by taking a good history. Because real borderline personality disorder starts in early teenage years, and its medication-induced mimic starts only after medication it rarely meets sufficient criteria. They are not the same phenomenon.
None of these mental illness diagnoses can be supported, because all are restricted, in both the DSM IV and ICD 10 by a “not caused by substance or medication” exclusion criterion.
This state of medication-induced brain toxicity (termed a toxidrome) should be recognised and coded as Adverse Effects of Medication and related conditions, or if restlessness, suicidality or aggression are prominent, as Neuroleptic Induced Akathisia, 333.99. If confusion and cognitive impairment are prominent it might be Substance Induced Delirium.
As the USA is also experiencing this epidemic of misdiagnosed neurotoxic ;Substance/medication induced disorders’ DSM-5 had to include a new set of diagnoses that are consistent with medication side effects as listed in USA product information for drugs used in psychiatry, but these adverse reactions are not mentioned in Australia. They have no numerical codes, as they are not mental illness but side effects:
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, American Psychiatric Association, 2013.
Antidepressant discontinuation syndrome
· Medication-induced movement disorders and other adverse effects of medication (p.709-714)
· Medication-induced delirium
· Antidepressant discontinuation syndrome
· Medication-induced Acute akathisia
· Medication-induced Acute dystonia
· Medication-induced Postural tremor
· Medication-induced Parkinsonism
· Neuroleptic malignant syndrome
· Medication-induced Tardive akathisia
· Medication-induced Tardive dystonia
· Antidepressant discontinuation syndrome
· Other adverse effects of medication
· DSM-5 333.99 Medication-induced acute and tardive akathisia
· Substance/Medication-induced I disorders p. 481, 487-490
· Substance/Medication-induced anxiety disorder
· Substance/Medication-induced delirium
· Substance/Medication-induced bipolar and related disorder
· Substance/Medication-induced depressive disorder
· Substance/Medication-induced neurocognitive disorder
· Substance/Medication-induced obsessive-compulsive and related disorders
· Substance/Medication-induced psychotic disorder
· Substance/Medication-induced sexual dysfunction disorder
· Substance/Medication-induced sleep disorder
· Substance-induced addictive disorders
If the condition not correctly diagnosed, it persists because the patients gets increasing doses of psychiatric drugs and eventually polypharmacy, often a haphazard accumulation, each added for a side effect, a mood disturbance, hypertension, weight loss or gastrointestinal symptoms. The consequences of overdosing are worse if drugs are synergistic for effects or if they have CYP450-based incompatibilities.[i]
Recovery occurs only when a clinician who can tell the difference between a toxidrome and the “functional” psychoses (which have no known causes):
· Takes a history of how the condition originated;
· Does a mental state examination;
· Diagnoses and confirms by testing for genetic vulnerability,
· And supervises a very slow withdrawal of the culprit drug or drugs in the right order.
Most patients recover but it takes a couple of years until they feel like their former selves again. Some are left with serious chronic neuroleptic-induced brain deficits (tardive dysmentia, dementia), the effects of strokes, diabetes, or akathisia may have become chronic and intractable.
There are other gateways into the iatrogenic patient role:
- · Amphetamine-, cannabis- or cocaine-induced psychosis, or that from any illicit drugs, ADHD drugs, (16% cases)
- · Herbs (4%)
- · Drugs given in anaesthesia (4%)
- · Or to augment opioids given for pain (5% causing serotonin toxicity)
- Or following any single or combined prescription of the 167 non-psychiatric medications, and anaesthetics that have psychiatric side effects in some people.
4 of my first sample of 85 had mental illness diagnosed before they got medication, 2 with schizophrenia, 2 bipolar and 6 others could not give a reliable account of why drugs were initially prescribed or what the first drug was.
Only 5 had ever been prescribed antidepressants on their own and they had tolerated antidepressants at a single dose but, as they had not been effective for their predicaments, doses were increased or antipsychotics. Then mood stabilisers had been added just as suggested in the graphics in ghost written Clinical Practice Guidelines which came from the fraudulent Texas Medication Algorithm Project.
When drugs that have withdrawal reactions are prescribed for what, in nature, should be a self-limiting brief psychotic episode (stress-induced or brief reactive psychosis or Schizophreniform disorder), it becomes hard to withdraw them so patients join the ranks of the chronically “mentally ill” suffering from toxidromes.
On drugs the have serious withdrawal effects (which can be delayed by many months like flashbacks from LSD), which they are taught to believe, is the depression or psychosis coming back.
That’s like the serotonin theory of depression and is PharMA Science or NON SCIENCE, nonsense.
9% of the population of Australia is taking psychiatric drugs, 5% are on antidepressants.
In USA 6% are on antipsychotics, making them the most commonly prescribed drugs but information on our percentages is not available in Australia.
About 1% of the population suffers from schizophrenia:
The World Health Organization's epidemiological studies over scores of years and across cultures has found that 0.5% to 1% have bipolar (manic depression), yet 10% of kids are so diagnosed in USA. Manic shift when someone is taking a substance of mediation is routinely being mistaken for new mental illness. They also found that biological depression is rare and treatable. The use of the term hypomania should not be used in the Product Information, because it miss-educates doctors and causes confusion.
Bipolar I is natural manic depression, but the DSM IV invented Bipolar II to accommodate manic shift on antidepressants.[ii] Bipolar I (formerly known as manic-depressive psychosis), is diagnostically limited in both phases (manic and depressive) by a “not caused by substance or medication” exclusion.
Bipolar II accommodates a medication-induced manic shift, adverse effects of medication, worsening depression and suicidality, serotonergic akathisia as well as natural exuberance, cyclothymia and excitability, within the embrace of American psychiatry’s socially constructed disorders.
Calling a condition with similar symptoms but a different cause by the name of the more serious condition causes a person to believe he has a mental illness and to accept long-term treatment.
On March 22 2004, US FDA issued a Public Health Advisory: “Worsening Depression and Suicidality in Patients, Adults and Children Being Treated with Antidepressant Medications” warning parents and caregivers that anxiety, agitation, panic attacks, insomnia, irritability, hostility, (code word for homicidal ideation) impulsivity, hypomania, and mania have been reported in adult and child patients being treated with antidepressants for major depressive disorder as well as for other indications, both psychiatric and nonpsychiatric. Daily monitoring was recommended.
40% of the small number of persons who do suffer from genuine schizophrenia or manic depression will also have relevant genetic mutations in metabolising genes. These people are hard to treat and require close monitoring with special
All product information now contains this warning, but it took 15 months after the warning was initially issued by the US FDA before it was included in Australian Product Information.
Akathisia is severe restlessness associated with inexplicable violence, suicide, and homicide. When a causal substance explains its onset, mania is a medication induced manic shift or an adverse drug reaction, not manic depression.
When the FDA issued the 2004 Public Health Advisory, the American Psychiatric Association immediately issued warnings about suicide induction.[iii]
The Royal Australian and New Zealand College of Psychiatrists refused and still refuses to do so, saying: “We are not convinced.”[iv]
Professor Ian Hickie calls the suicide reports in the literature “anecdotal.” In response to an audience question about the work of Professor Peter Gotzsche[v] and Robert Whitaker[vi] during a television program, he replied with a non sequitur, evading the question:
I think it's sad that we have visitors from other countries, the United States, UK, come here and bring a media line that is not very helpful.[vii]
Gotzsche and Whitaker have researched the drug company frauds and unearthed the failed clinical trials that underpin this mental health disaster. It is obvious from studies that look at the effectiveness of drugs on mental health patients, that these medications are not effective and are being overused. They conclude that it is the drug companies who are benefitting, and not the patients.
More information on Professor Peter Gotzsche's work investigating the efficacy of antidepressants can be found here:
Persons being treated for mental illness diagnosed and confirmed before medication comprise a tiny minority of those I see.
It is the population with side effects that manifest as the huge increase in demand (and costs) since the first of the new generation drugs, Prozac, was introduced, in 1990.
An adverse response to the first drug or illicit substance should suggest that the patient might have a diminishing metabolism genetic polymorphism. This information can be gained, in retrospect, by taking a good history and a buccal swab.
This problem is the outcome of the education of psychiatrists by the pharmaceutical industry, which fund key opinion leaders, guideline writers, beyondblue, Lifeblood and Sphere, which are all organisations that provide psychiatric education that serves their commercial interests and all are funded by the Pharma Collaboration.
This is in conflict with the altruism, the need to put patients first, that one associates with the practice of medicine and is in the realms of the unthinkable.
Drug-company-funded Key Opinion Leaders write tomes on “treatment-refractory schizophrenia”:
The relationship of drug side effects and genes shows that most persons so diagnosed are suffering from side effects, and only a few from side effects superimposed on pre-existing mental illness.
Neurotoxic states (toxidromes) Mental illness should first be diagnosed before treatment that has similar side effects is introduced.
Misunderstanding of the causes of psychiatric and physical symptoms, uninformed prescribing, polypharmacy account for deteriorating outcomes in serious (read medicated) mental illness. The evidence from epidemiologists is that the rates of death, suicide and violence have increased hugely for (treated) serious mental illness and are 20 times as high now as they were before we started medicating for mental illness, before chlorpromazine and the tricyclic antidepressants.
I quote from my Akathisia Homicides paper:
Deteriorating outcomes in mental illness, deaths, violence, and suicide rates have been documented by epidemiologists and have increased up to 20-fold since 1924.
Lifetime suicide rates in treated schizophrenia: 1875–1924 and 1994–1998 cohorts compared:
The epidemiology of excess mortality in people with mental illness:
Do nations' mental health policies, programs and legislation influence their suicide rates? An ecological study of 100 countries:
Schizophrenia: A Concise Overview of Incidence, Prevalence, and Mortality:
Some people taking psychiatric drugs develop akathisia and some people who develop akathisia kill themselves or others.
Yet the drugs can be effective in persons suffering serious depression, provided their doses are adjusted according to their ability to metabolize them normally and there is informed monitoring.
Everyone except psychiatrists knows it is the drugs; they have trained incapacity and willful blindness.
And it is in the politicians' "too hard basket" so we have a massive, escalating public health problem.
So what is happening in Australia?
Do we need a public inquiry into the influence of the pharmaceutical industry and the prescribing behaviours of doctors educated by the pharmaceutical industry and its agents?
[ii] Criteria for Manic Episode DSM IV TR etc
A. A distinct period of abnormally and persistently elevated, expansive, or irritable mood, lasting at least 1 week (or any duration if hospitalization is necessary).
B. During the period of mood disturbance, three (or more) of the following symptoms have persisted (four if the mood is only irritable) and have been present to a significant degree:
1. inflated self-esteem or grandiosity
2. decreased need for sleep (e.g., feels rested after only 3 hours of sleep)
3. more talkative than usual or pressure to keep talking
4. flight of ideas or subjective experience that thoughts are racing
5. distractibility (i.e., attention too easily drawn to unimportant or irrelevant external stimuli)
6. increase in goal-directed activity (either socially, at work or school, or sexually) or psychomotor agitation
7. excessive involvement in pleasurable activities that have a high potential for painful consequences (e.g., engaging in unrestrained buying sprees, sexual indiscretions, or foolish business investments)
C. The symptoms do not meet criteria for a Mixed Episode (see Criteria for Mixed Episode).
D. The mood disturbance is sufficiently severe to cause marked impairment in occupational functioning or in usual social activities or relationships with others, or to necessitate hospitalization to prevent harm to self or others, or there are psychotic features.
E. The symptoms are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication, or other treatment) or a general medical condition (e.g., hyperthyroidism).
Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.
A Manic Episode is defined by a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood. This period of abnormal mood must last at least 1 week (or less if hospitalization is required) (Criterion A).
[iii] American Psychiatric Association. (2006). American Psychiatric Association Practice Guidelines for the treatment of psychiatric disorders: compendium 2006. American Psychiatric Pub.
[iv] Yallop, R Suicide warning urged for Prozac March 25, 2004 The Australian.
[v] Gøtzsche P. Deadly Medicines and Organized Crime. How Big Pharma has Corrupted Healthcare. Radcliffe Publishing London • New York
[vi] Whitaker, R. (2005). Anatomy of an epidemic: Psychiatric drugs and the astonishing rise of mental illness in America. Ethical Human Sciences and Services, 7(1), 23-35.
[vii] “Mental As” Q&A Australian Broadcasting Corporation broadcast October 2015.