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Review: Your Drug May Be Your Problem
November 17, 2004
by Byron Fraser

First published in the Fall 2000 In A Nutshell

Your Drug May Be Your Problem:
How and Why to Stop Taking Psychiatric Medications
(Persus Books/Harper Collins Publishers, 1999. 272 pages)

by Peter Breggin, M.D. and David Cohen, Ph.D.

Review commentary and select quotes compiled by Byron Fraser


This is the best selling book first published late last year (and now due to come out in a large paperback edition as of Nov., 2000) which numerous people I ve met in the local mental health community have been vigorously recommending, promoting, and/or disputatiously talking up, seemingly non-stop, of late; it is having a major impact. The thing is that, for years, people “in the system” wanting to access alternatives to what passed for “treatment” (i.e., essentially drugging) have had no ready guide to either the risks entailed in taking their prescribed medications or the often extremely debilitating withdrawal syndromes associated with going off of their medications; there simply has been nothing like informed consent, full disclosure, or any sort of succinct informational source we could direct people to which covers all of this. Now, thankfully, we have this factually power-packed, up-to-date, authoritative and definitive capsule summary, grounded in solid medical research, of everything anyone considering taking -- or wondering about stopping taking -- psychiatric drugs really needs to know. Intended for patients, laymen and professionals alike, it is also a must-read for all health care service providers and advocates working in general fields related to psychiatry. Adverse effects of all categories of psychiatric drugs currently in use -- including minor and major tranquilizers, antidepressants, stimulants, sleeping pills, neuroleptics/antipsychotics, and “mood stabilizers” -- are listed in detail along with the most comprehensive summary of psychiatric drug withdrawal reactions (e.g., “relapse” and “rebound” effects) available anywhere. Of course, the authors -- world-famous psychiatrist/ author and Director of the International Center for the Study of Psychiatry and Psychology, Dr. Peter Breggin, and expert psychiatric drug researcher, Professor David Cohen, of the University of Montreal -- have a point of view, but their intent is not to preach or proselytize. Rather, it is to aid in harm reduction via contributing what they can to maximally efficacious decision-making processes -- at all levels. This review is limited to just highlighting a few of the very relevant and timely issues treated of at length in the book. Its major premise, briefly, is:

“...we believe that the benefits of psychiatric drugs are vastly exaggerated, that their disadvantages are too often minimized, and that there is far too little information about how to stop taking them. This book is, in fact, the first and only one to focus on the overall problem of why and how to stop taking psychiatric medication.” (--p. 28)

Quotes and Quick Facts

1) The Current Situation

“...all psychiatric drugs have well-documented, serious hazards.” (--p. 12)

“Evidence suggests that all psychiatric drugs can produce withdrawal reactions.” (--p. 26)

“...all psychiatric drugs are drugs of dependence [according to accepted medical definitions of physical dependence; see same page --B.F.].” (--p. 145)

“The longer you take a tranquilizer, the higher the doses, and the more abrupt the withdrawal -- the more serious your withdrawal reactions are likely to be.” (--p. 148)

“Overconfidence in clinical judgment concerning the long-term safety of drugs has led to an even more tragic outcome. Millions of patients have been afflicted with gross neurological disorders from taking antipsychotic drugs. This class of drugs -- ... -- was used for two decades before it was generally recognized that the entire group frequently causes tardive dyskinesia and neuroleptic malignant syndrome [and they are prescribed more frequently than ever, in spite of this, to this day --B.F.].” (--p. 49)

“FDA records contain thousands of reports of severe and life-threatening reactions to almost every psychiatric drug in current use....Hence FDA approval should not be interpreted as indicating that a given drug is without serious and potentially fatal adverse reactions. On the contrary, all psychiatric drugs approved by the FDA can pose enormous risks even in routine use.” (--pp. 102-03)

“More than 50 percent of patients drop out of psychiatric drug treatment 'due to side effects,' including drug-induced 'sleep problems, anxiety and agitation, and sexual dysfunction'.” (--p. 31)

“Although there is some variation among medications in this class [neuroleptics --B.F.], all of them can cause toxic psychoses with delirium, confusion, disorientation, hallucinations, and delusions. Probably all of them also cause depression....Most of them can cause sedation and fatigue, seizures, weight gain, dangerous cardiac problems, hypotension..., a variety of gastrointestinal problems such as paralysis of the bowels, hormonal abnormalities..., sexual dysfunctions..., skin rashes and sensitivity to sunlight, eye disorders, allergic reactions...and disorders of body temperature regulation....” (--pp. 80-81)

2) Are Biochemical Imbalances and Brain Diseases Treated by Psychiatric Drugs?

The simple scientific answer is an emphatic “No”--: no underlying causal pathology for any psychiatric disorder has ever been identified to be so “treated” or “cured”. What psychiatric drugs do is to treat symptoms of mental disorders temporarily without affecting their causes. This is admitted by all. Hence: “In the field of mental health, not a single physical explanation has been confirmed for any of the hundreds of psychiatric 'disorders' listed in the DSM-4. A recent editorial in the American Journal of Psychiatry (Tucker, G.J. 1997. 'Editorial: Putting DSM-4 in perspective.' No. 155, pp. 159-61) states the case plainly: 'As yet, we have no identified etiological agents for psychiatric disorders'.” (--p. 112)

“The concept of biochemical imbalances in people diagnosed with depression, anxiety and other 'disorders' remains highly speculative and even suspect...there is at present no way to prove its validity. Specifically, we lack the technical capacity to measure biochemical concentrations in the synapses between nerve cells....
...all psychiatric drugs directly affect the brain s normal chemistry by disrupting it....
It is important to keep this in mind: the brain is always impaired by psychiatric drugs....this conclusion...is supported by...an enormous amount of scientific research detailing the biochemical imbalances in the brain created by psychiatric medication. These drug-induced biochemical imbalances commonly cause psychiatric disorders in routine psychiatric practice.
Even if some emotional problem turned out to be caused by subtle, as-yet-undetected biochemical imbalances, this finding would not be a rational justification for using any of the psychiatric drugs that are currently available. Because they impair normal brain function, such drugs only add to any existing brain malfunction....
If psychiatric drugs could correct specific biochemical imbalances, specific types of drugs for specific disorders would be available. But this is not the case....
No psychiatric drug has ever been tailored to a known biochemical derangement.... At the same time, no biochemical imbalances have ever been documented with certainty in association with any psychiatric diagnosis. The hunt goes on for these illusive imbalances; but their existence is pure speculation, inspired by those who advocate drugs. (Footnote 7, Ch. 2: Within the privacy of professional writings, various experts in the field agree that no biochemical abnormalities have been demonstrated in psychiatric disorders. Textbooks are filled with speculations, often specifying several potential biochemical mechanisms, but in no case can they claim that such speculations have been proven. Indeed, the textbook chapters usually conclude with an admission that nothing has been proven but that 'breakthroughs' are anticipated. [See also, especially, in this regard, the recent very scholarly summary by Al Siebert, Ph.D., in the Ethical Human Sciences and Services journal, Vol. 1, No. 2, 1999 from the International Center for the Study of Psychiatry and Psychology: 'Brain Disease Hypothesis for Schizophrenia Disconfirmed by All Evidence.' Also in the same issue focusing on the theories about and identification of -- as well as current treatments for -- 'schizophrenia', is the important article by Jay Joseph, Ph.D., 'The Genetic Theory of Schizophrenia: A Critical Overview.' It can be ordered from Support Coalition International -- toll free: 1-877-623-7743/ Fax: 1-541-345-3737 -- or from Springer Publishing Company: 1-212-941-7842 --B.F.]).” (--p. 33-35)

3) If Psychiatric Drugs Don t Cure Physically Caused Organic Brain Diseases Or Mental Illnesses , What Do They Do?

“Psychiatric drugs do not work by correcting anything wrong in the brain. We can be sure of this....There are no known biochemical imbalances and no tests for them. That s why psychiatrists do not draw blood or perform spinal taps to determine the presence of a biochemical imbalance in patients. They merely observe the patients and announce the existence of the imbalances....
Ironically, psychiatric drugs cause rather than cure biochemical imbalances in the brain. In fact, the only known biochemical imbalances in the brains of patients routinely seen by psychiatrists are brought about by the psychiatrists themselves through the prescription of mind-altering drugs.
Psychiatric drugs 'work' precisely by causing imbalances in the brain -- by producing enough brain malfunction to dull the emotions and judgment or produce an artificial high....” (--p. 41)

“...few, if any, psychiatric drugs have been proven to bring about long-term beneficial effects, even
by standards of researchers who favor drugs.
There are no lifetime studies of drug efficacy....most studies of psychiatric drugs last four to six weeks and often have to be statistically juggled to make them look positive. Even when researched over the longer term, these drugs tend to be associated with increasingly adverse effects and no evidence of efficacy....There is simply no justification whatsoever for the commonly made claim that some people need to take psychiatric drugs for the rest of their lives.
In fact, most of the problems involved in 'doing without drugs' are the result of drug withdrawal. Patients most often have trouble stopping drugs not because they are useful but because they create dependency.” (--p. 193)

“Contrary to claims, neuroleptics have no specific effects on irrational ideas (delusions) or perceptions (hallucinations).” (--p. 77)

4) Do Psychiatric Drugs Prevent Suicide and Violence?

“...the FDA has never approved a drug specifically for the prevention or control of suicide or violence.
More generally, there is no convincing evidence that any psychiatric medication can reduce the suicide rate or curtail violence. But there is substantial evidence that many classes of psychiatric drugs -- including neuroleptics (antipsychotics), antidepressants, stimulants, and minor tranquilizers -- can cause or exacerbate depression, suicide, paranoia, and violence.” (--p. 38)

(While this is true, the main argument used by institutional/corporate, political and media proponents of the expansion of forced treatment/compulsory outpatient committal/ involves deliberate perpetuation and exacerbation of the false public stereotype of people with mental disabilities as innately more violent than the general public. For definitive studies refuting this commonplace myth, see Mental Illness and Violence: Proof or Stereotype [National Clearing House On Family Violence, 1996. Ph.: 1-800-267-1291] and, in the U.S., The MacArthur Violence Risk Assessment Study [1998] --B.F.)

“Numerous suicide and murder cases have involved patients who have taken SSRIs [serotonin reuptake inhibitors -- such as Prozac, Zoloft, Paxil, Luvox, etc. --B.F.] for a few days or longer.” (--p. 69)

(Luvox was being taken by Eric Harris at the time he committed the murders at Columbine High School in Littleton, Colorado on April 20, 1999, for example. And the now-accepted -- legally -- “Prozac Defense” has become quite commonplace due to the numerous serious violent offences committed by people having reactions to that particular drug. --B.F.)

5) What Are The Dangers? Tardive Dyskinesia/Dystonia/Akathisia, Neuroleptic Malignant Syndrome, and other “side effects”.

“For the neuroleptics that have been extensively studied...the rates of tardive dyskinesia and neuroleptic malignant syndrome are very high.” (--p. 47)

“Tardive dyskinesia (TD) is a common and yet potentially disastrous adverse reaction to all of the neuroleptic drugs. TD involves irreversible abnormal movements of any of the voluntary muscles of the body. It commonly afflicts the face, eyes, mouth, and tongue, as well as the hands and arms, feet, and legs, and torso. It can also affect breathing, swallowing, and speech. In some cases, spasms of the eyes are so severe that the person cannot see.
One variant of TD is tardive dystonia, which involves painful spasms, often of the face and neck. Tardive dystonia can be disfiguring and disabling, potentially impairing even the ability to walk.
Another variant of TD is tardive akathisia. The individual is virtually tortured from inside his or her own body as feelings of irritability and anxiety compel the person into constant motion, sometimes to the point of continuous suffering....
Another disastrous reaction caused by neuroleptic drugs is neuroleptic malignant syndrome (NMS). Similar to viral brain inflammation (encephalitis), NMS is characterized by severe abnormal movements, fever, sweating, unstable blood pressure and pulse, and impaired mental functioning. Delirium and coma can also develop. NMS can be fatal....Patients who recover may be left with varying defrees of irreversible mental impairment as well as permanent abnormal movements....
The rates of TD are extremely high. Many standard textbooks estimate a rate of 5%-7% 5 per year in healthy young adults. The rate is cumulative so that 25%-35% of patients will develop the disorder in 5 years of treatment. Among the elderly, rates of TD reach 20% or more per year. (Footnote No. 35, Ch. 4: Bezchlibnyk-Butler and Jeffries [Clinical Handbook of Psychotropic Drugs, 1996], estimate that 37% of patients will develop TD in the first 5 years and 56% after 10 years. )” (--pp. 78-79)

“Mania, depression, and other abnormalities of emotional control commonly result from taking psychiatric drugs. These drug-induced 'mood disorders ' are mentioned many times in the...(DSM-4), which is the source of all official diagnoses in psychiatry. The manual makes clear that a number of psychiatric drugs, including antidepressants, can cause mania. As well, Patients often become more depressed on antidepressants....Almost all psychiatric drugs -- from the minor tranquilizers to stimulants... -- can cause depression.” (--pp. 54- 56)

6) Is Drug Treatment Superior to Non-Drug Treatment or Psychotherapy?

“...the effectiveness of most or all psychiatric drugs remains difficult to demonstrate. The drugs often prove no more effective than sugar pills, or placebos....
...Studies show that at least 75 per cent of the antidepressant effect is a placebo effect....” (--p. 37)

“Claims are usually made for the superiority of medication; it is supposedly faster, more economical, and more effective. In reality, however, the comparable or superior efficacy of psychotherapeutic interventions, even for severely disturbed people, is much better documented than most therapists or the public realize. [Numerous source references cited --B.F.]....
Therapy has also been shown to be more effective than drugs in helping patients diagnosed with their first 'schizophrenic' break. Nowadays it is argued that these people must have drugs and that psychotherapy is futile; yet nothing could be further from the truth. In controlled studies, untrained therapists in a home-like setting have proven more successful than drugs and mental hospitals in treating patients diagnosed with their first episode of schizophrenia. A key factor was the caring, non-coercive approach of these therapists.” (--p. 40)

(See especially also, in this regard, the report on recent longitudinal studies in Sweden comparing outcomes of first time psychotic patients treated with neuroleptic drugs vs. those not so treated in the essay collection, edited by Dr. Lars Martensson, Deprived of Our Humanity: The Case Against Neuroleptic Drugs [1998]. This 224 page paperback -- which is one of the best introductory volumes to current issues in psychiatry for giving to laymen, family members, and mental health professionals -- is available from Support Coalition International or from: The VOICELESS, Movement for Patient s Rights, P.O. Box 235, CH-1211 GENEVA 17, Switzerland. [It also has excellent sections on “Withdrawal Symptoms Connected with Cessation of Psychiatric Drugs”, “How to Come Off Psychiatric Drugs”, “Psychiatric Living Wills” and much else. Highly recommended!] Also very relevant is the work of Dr. Loren Mosher, former Chief of the National Institute for Mental Health s [NIMH s] Center for Studies of Schizophrenia, documented in “Soteria: a therapeutic community for psychotic persons” in Psychosocial Approaches to Deeply Disturbed Patients [1996], edited by P. Breggin and E.M. Stern, as well as Community Mental Health: Principles and Practice [1994], by L.R. Mosher and L. Burti. Finally, there is a very recent superb brief treatment of this subject-area titled “Prepsychotic Treatment for Schizophrenia: Preventative Medicine, Social Control, or Drug Marketing Strategy?” by Richard Gosden in the above-mentioned Vol. 1, No. 2, issue of the Ethical Human Sciences and Services journal. --B.F.)

“According to an international study by the World Health Organization [see: 'WHO studies of schizophrenia: An overview of the results and their implications for an understanding of the disorder', 1996, by G de Girolano in Psychosocial Approaches to Deeply Disturbed Patients --B.F.], less industrialized cultures characterized by extended families have a very positive effect on the recovery of individuals who are diagnosed as schizophrenic -- in contrast to their counterparts in Western cultures, where isolated families are more common....a large proportion of very disturbed individuals labeled schizophrenic had complete recoveries. Tragically, this study also showed that the availability of modern psychiatric treatment with drugs has a negative effect on the outcome for people diagnosed as schizophrenic....” (--p. 41)

7) Basic Guidelines for Drug Withdrawal

“We can sum up the most prudent and sensible way to stop taking psychiatric drugs in one short sentence: Plan it well and go slowly. Regardless of the drug you are using and the problems it may have created in your life, a well-planned, gradual withdrawal has the best chance to succeed.” (--p. 111)

“Beware! It s not a good idea to abruptly stop taking drugs without first making sure that there s no danger involved in doing so. In our opinion, it is almost always better to err in the direction of going too slowly rather than too quickly.” (--p. 133)

“The...best approach is to plan a slow, gradual withdrawal involving close monitoring and a systematic, ongoing program of information, counseling, and reassurance. Unfortunately, however, abrupt withdrawal remains very common in clinical practice. Abrupt withdrawal is imprudent and may result in additional distress and disability.” (--p. 172)

“All psychiatric drugs can produce unpleasant, disturbing reactions upon withdrawal or discontinuation....However, doctors are too often unfamiliar with withdrawal problems associated with many of the...psychiatric drugs they routinely prescribe.
...even when doctors do know about the dangers of withdrawal problems from drugs, they often fail to warn their patients. (Footnote 1, Ch. 9: Young ... Currie, 1997. 'Physicians knowledge of antidepressant withdrawal effects: A survey.' Journal of Clinical Psychiatry. Even with respect to tardive dyskinesia, an often irreversible movement disorder frequently produced by neuroleptic drugs and mentioned in all information sources about these drugs, surveys show that psychiatrists admit that they routinely fail even to mention this effect to patients before prescribing [see further: Cohen, D. 1997. 'A Critique of the Use of Neuroleptic Drugs in Psychiatry.' In From Placebo to Panacea: Putting Psychiatric Drugs To The Test, Fisher & Greenberg, eds.]) , medical ethics and sound practice require that physicians advise patients about withdrawal problems. There is no legitimate excuse for not doing so.” (--p. 142)

8) Rebound and Relapse Effects (Does continued use of psychiatric drugs actually prevent relapse?)

“In terms of relapse rates,prolonged drug treatment appears to be no better than [complete cessation and withdrawal with] a gradual tapering [vis-à-vis prevention].” (--p. 165)

“Psychotic withdrawal symptoms are variously called tardive psychosis, super sensitivity psychosis, or withdrawal psychosis. Frequently accompanied by abnormal movements, they include hallucinations, delusions, confusion, and disorientation.
After years of suppression of the dopamine system by these drugs, the brain compensates for their effects. When the drugs are discontinued, the hyper-aroused dopamine system takes over. Psychotic reactions [which then often occur] upon abrupt withdrawal have been observed [even] in individuals with no history of psychotic symptoms, such as patients taking neuroleptics for tic disorders.” (--p. 163)

“In cases where patients are withdrawn from extended neuroleptic use, much of what gets called 'schizophrenic' or 'psychotic' relapse may actually be unrecognized withdrawal reactions. Withdrawal symptoms such as agitation, restlessness, and insomnia are also likely to be mistakenly attributed to the patients mental condition.
Indeed, because of the resemblance between many withdrawal symptoms and patients' prior emotional problems, clinicians not only blame the reaction on the 'underlying disorder' but also recommend continued treatment with the offending agent.” (--p. 165)

“We...suggest that a sound attempt be made to answer two important questions: Do 'discontinuation' or 'withdrawal' effects drive people to remain on their drugs indefinitely? And do these effects mistakenly convince doctors that patients 'need' their drugs?” (--p. 147)

9) Conclusion: There Are Humane, Realistic Alternatives (Or Should Be)

There is a great, great deal more in Your Drug May Be Your Problem about why things are the way they currently are, many more details about planning your or your child's withdrawal, and non-drug therapy options, etc., but the above excerpts will hopefully have given the interested reader an essential grasp of the important issues dealt with in plain English and “in a nutshell”, as we like to say around here. The book s concluding Chapter 13, outlining 12 “Psychological Principles for Helping Yourself and Others Without Resort to Psychiatric Medications” (page 203), was also found to be an especial inspiration by this reviewer. We can move beyond this stage of suffering and harm that many of us have personally witnessed and lived through.

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