Thank you, this is beautifully stated and so important. When I was suffering from grief, trauma and isolation after a big move followed by a tragic death in the family, all my insurance would cover was monthly therapy sessions of 45 minutes which required a diagnosis of depression or anxiety. They quickly prescribed meds which I only took briefly. What I really needed was a weekly support group and support in making social connections. Even most churches have abdicated responsibility for comfort and emotional support, seeing "mental illness" as an individual, medical issue rather than a symptom of collective social dysfunction. We must do better. This movement to revolutionize the field and stop this mental health malpractice is long overdue. Well done.
Yes, I am quite certain of this. Asexuality is not a natural state of being for a human - it is about as detached from humanness as one can be for it is the negation of the very object of life, that is, propagation and procreation. They are most certainly people who had been on Selective Serotonin Reuptake Inhibitors and could not piece together what actually happened - those who entered treatment in their late teens or adulthood could for they had many a memories of a trifling, unabating libido. But those medicated right at the commencement of adoloscence? They start identifying as "asexuals"
They already have a response for any of our concerns about side effects…why are you so obsessed with me having sex? We’re not hurting anyone…the world is overpopulated….climate change, etc.
Wonderfully written thank you! I’ve been following the great works of David Healy, and the RxISK database, for years. It is all such a frightening situation bulldozed by “policies” and profit and sadly yes not helped by no informed consent what so ever and a still too high (priest) trust in white coats.
I feel like this makes light of severe depression. I am not sad. Without antidepressants I would be dead,so I consider the side effects completely acceptable.
No- this article by no means makes light of depression- and in fact honors informed consent and a high ethical standard for those who are suffering. Antidepressants do not save lives- and no reasonable clinician would ever state such a thing. Antidepressants increase the risk of suicide, self injury and a range of adverse effects- and this article is about the serious effects of taking antidepressant drugs. Severe depression is a condition that requires effective support and a high quality of care- which not many are receiving. If you believe a pill saved your life... well that is your truth and true for you. However, as a clinical psychologist the ethical standard is high to carefully articulate what drugs are and What drugs are NOT.
If you laid all the psychiatrists end to end, I’m sure they would all be grateful, but they’d still point in different directions.
I’ve seen practitioners who have prescribed better lifestyle choices, who interpreted “do no harm” as only avoiding sins of commission, who insisted that a prior practitioner was wrong about everything and the only helpful one, a committed empiricist, whose regime has kept me functioning for the past 20 years.
Doctors are necessarily limited by their experience and the reliability of patient reports on efficacy and adverse effects. Sometimes family reports and behavioral observations. It’s an art not a science. What pharmacological science there is more closely resembles anecdotal evidence for many drugs prescribed to treat depressive symptoms than ordinary science. Little attempt is made to overcome the mind body dichotomy, and psychiatric symptoms are too often treated as having no physical substrate but as having a free-floating metaphysical nature. The principles of analytical medicine, which works brilliantly at the macro level for other organs are misapplied to the brain to discretize continuously varying conditions. “Ah, it says on your chart that you have GAD. Here have a benzo.” Patients never present with all of their conditions on display. The bipolar patient never shows up saying “Doc! I feel GREAT!!! You’ve got to help me.” She shows up looking for all the world as being in a major depressive episode. Patients don’t generally show up in the grip of a panic attack.
Now, here comes my criticism of the informed consent model of practice.
People, especially patients, suffer from marked difficulty making decisions under uncertainty, especially those involving their own lives. That’s why we hire experts to lay out the uncertainty, assess risks and rewards, clearly make assumptions and then step up and make a recommendation. Declining to do offer the resolution and offering only the downsides (no more orgasms again, mate) takes away the agency of taking or rejecting a recommendation. It’s manipulation in the name of protecting the patient from making “bad” choices based on their own values.
Finally, there is the tyranny of lowest common denominator consensus positions. Remember don’t eat eggs? Never mind, dietary cholesterol is no longer a concern. My current favorite is that benzodiazepines have become geriatric fentanyl on the basis of increased fall risk and possible cognitive impairment. Why these risks had not become prominent in the first 60 years of widespread use is unknown. When my prescribing psychiatrist retired six years ago, I was unable to get a refill or a substitute anxiolytic. Although I had become dependent, I was not addicted (I quit cold turkey because what I had left had to last the rest of my life.) As someone who isn’t doing as well as he had been, has managed orthostatic hypotension since puberty and has an actuarial shelf life of less than 10 years, I much resent having that risk/reward decision taken from me. (Poor, poor, pitiful me. 🎻🎻🎻)
How can you know you would be dead? Obviously, you can’t and it’s an overused expression in mental health. It should be reserved for real scenarios like cancer or surgery.
When I was suffering from depression, perhaps as a result of alcohol, and/or self-medicating with alcohol, there was this huge emotional gap that I needed to address. SSRI's didn't help, and, yes, caused the sexual dysfunction you described, which I am relieved to say, didn't have the permanent effects you suggest are possible.
The only thing that worked for me was CBT, which is why I wrote a book about my recovery, (no plug here!) and why I work as a CBT Alcohol, Anxiety and Depression Counsellor today.
There are some things, however painful, that you need to work through, and the short-term "relief" of SSRI's is perhaps not always a permanent solution for everybody.
Thank you so much for sharing this important article, Roger :)
Thank you, this is beautifully stated and so important. When I was suffering from grief, trauma and isolation after a big move followed by a tragic death in the family, all my insurance would cover was monthly therapy sessions of 45 minutes which required a diagnosis of depression or anxiety. They quickly prescribed meds which I only took briefly. What I really needed was a weekly support group and support in making social connections. Even most churches have abdicated responsibility for comfort and emotional support, seeing "mental illness" as an individual, medical issue rather than a symptom of collective social dysfunction. We must do better. This movement to revolutionize the field and stop this mental health malpractice is long overdue. Well done.
In the lgbt 'banner' there is a new 'category' of asexual. Usually in their teens and 20s, I have suspected these people are likely pharma victims.
Yes, I am quite certain of this. Asexuality is not a natural state of being for a human - it is about as detached from humanness as one can be for it is the negation of the very object of life, that is, propagation and procreation. They are most certainly people who had been on Selective Serotonin Reuptake Inhibitors and could not piece together what actually happened - those who entered treatment in their late teens or adulthood could for they had many a memories of a trifling, unabating libido. But those medicated right at the commencement of adoloscence? They start identifying as "asexuals"
They already have a response for any of our concerns about side effects…why are you so obsessed with me having sex? We’re not hurting anyone…the world is overpopulated….climate change, etc.
Wonderfully written thank you! I’ve been following the great works of David Healy, and the RxISK database, for years. It is all such a frightening situation bulldozed by “policies” and profit and sadly yes not helped by no informed consent what so ever and a still too high (priest) trust in white coats.
Excellent article! This truth needs to become mainstream
Emotion is Not a Disoder
https://open.substack.com/pub/animaltheoryofemotion/p/animal-theory-of-emotion-emotion?r=49in60&utm_campaign=post&utm_medium=web
I feel like this makes light of severe depression. I am not sad. Without antidepressants I would be dead,so I consider the side effects completely acceptable.
No- this article by no means makes light of depression- and in fact honors informed consent and a high ethical standard for those who are suffering. Antidepressants do not save lives- and no reasonable clinician would ever state such a thing. Antidepressants increase the risk of suicide, self injury and a range of adverse effects- and this article is about the serious effects of taking antidepressant drugs. Severe depression is a condition that requires effective support and a high quality of care- which not many are receiving. If you believe a pill saved your life... well that is your truth and true for you. However, as a clinical psychologist the ethical standard is high to carefully articulate what drugs are and What drugs are NOT.
If you laid all the psychiatrists end to end, I’m sure they would all be grateful, but they’d still point in different directions.
I’ve seen practitioners who have prescribed better lifestyle choices, who interpreted “do no harm” as only avoiding sins of commission, who insisted that a prior practitioner was wrong about everything and the only helpful one, a committed empiricist, whose regime has kept me functioning for the past 20 years.
Doctors are necessarily limited by their experience and the reliability of patient reports on efficacy and adverse effects. Sometimes family reports and behavioral observations. It’s an art not a science. What pharmacological science there is more closely resembles anecdotal evidence for many drugs prescribed to treat depressive symptoms than ordinary science. Little attempt is made to overcome the mind body dichotomy, and psychiatric symptoms are too often treated as having no physical substrate but as having a free-floating metaphysical nature. The principles of analytical medicine, which works brilliantly at the macro level for other organs are misapplied to the brain to discretize continuously varying conditions. “Ah, it says on your chart that you have GAD. Here have a benzo.” Patients never present with all of their conditions on display. The bipolar patient never shows up saying “Doc! I feel GREAT!!! You’ve got to help me.” She shows up looking for all the world as being in a major depressive episode. Patients don’t generally show up in the grip of a panic attack.
Now, here comes my criticism of the informed consent model of practice.
People, especially patients, suffer from marked difficulty making decisions under uncertainty, especially those involving their own lives. That’s why we hire experts to lay out the uncertainty, assess risks and rewards, clearly make assumptions and then step up and make a recommendation. Declining to do offer the resolution and offering only the downsides (no more orgasms again, mate) takes away the agency of taking or rejecting a recommendation. It’s manipulation in the name of protecting the patient from making “bad” choices based on their own values.
Finally, there is the tyranny of lowest common denominator consensus positions. Remember don’t eat eggs? Never mind, dietary cholesterol is no longer a concern. My current favorite is that benzodiazepines have become geriatric fentanyl on the basis of increased fall risk and possible cognitive impairment. Why these risks had not become prominent in the first 60 years of widespread use is unknown. When my prescribing psychiatrist retired six years ago, I was unable to get a refill or a substitute anxiolytic. Although I had become dependent, I was not addicted (I quit cold turkey because what I had left had to last the rest of my life.) As someone who isn’t doing as well as he had been, has managed orthostatic hypotension since puberty and has an actuarial shelf life of less than 10 years, I much resent having that risk/reward decision taken from me. (Poor, poor, pitiful me. 🎻🎻🎻)
How can you know you would be dead? Obviously, you can’t and it’s an overused expression in mental health. It should be reserved for real scenarios like cancer or surgery.
When I was suffering from depression, perhaps as a result of alcohol, and/or self-medicating with alcohol, there was this huge emotional gap that I needed to address. SSRI's didn't help, and, yes, caused the sexual dysfunction you described, which I am relieved to say, didn't have the permanent effects you suggest are possible.
The only thing that worked for me was CBT, which is why I wrote a book about my recovery, (no plug here!) and why I work as a CBT Alcohol, Anxiety and Depression Counsellor today.
There are some things, however painful, that you need to work through, and the short-term "relief" of SSRI's is perhaps not always a permanent solution for everybody.
Thank you so much for sharing this important article, Roger :)
How do I find a clinician in my area?
Do I need to become a part of the paid connection or what is the process?
https://youtu.be/eTrRpL0uaRY?si=LqxlfDW9Ilfn1vCt