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January 21, 2018

Psychiatrists Roadblock Psychiatric Drug Withdrawal Initiatives: Part 2

by Peter C. Gøtzsche, MD

From organised denial to outright resistance: Rejection of a symposium on withdrawal at the psychiatrists’ annual meeting

Can anything be more important for psychiatrists to discuss at their annual meeting than how they may help their patients come off their psychiatric drugs in the safest and best way?

I don’t think so. In Denmark, about 5% of the whole population has become dependent on psychiatric drugs. These drugs are all neurotoxic (1) and particularly harmful when used long term (1-5), which is usually the case. Therefore, by far most patients would do better if they had their drugs slowly withdrawn.

Psychiatrist Jan Vestergaard Christiansen – who has withdrawn many patients from benzodiazepines – submitted a proposal for a two-hour symposium about withdrawing benzodiazepines for the 2018 annual meeting of the Danish Psychiatric Association. He had planned four lectures: one on the pharmacology of benzodiazepines by a neuroscientist, one on a manual for cognitive behavioral therapy in the treatment of benzodiazepine addiction by himself, one on withdrawal of psychiatric drugs by me, and one on the treatment of dual addiction to alcohol and benzodiazepines by a psychiatrist.

The Board of the Association replied: “We have received many proposals, which we unfortunately did not have room for, and your symposium was not accepted. The Board very much encourages you to apply again for the 2019 annual meeting.”

As I was surprised by this prioritization, I looked at the programme for the 2017 meeting, which, like the 2018 meeting, ran over three days. There was a symposium called “Mortality and antipsychotics.” Psychiatrist Jimmi Nielsen announced it by stating that the risks for life-shortening adverse effects of antipsychotics should be weighed against the risk of untreated psychosis where there is an increased risk of suicide and unnatural deaths. He also noted that, “In recent years, large studies have been published that show that the use of antipsychotics is associated with increased average survival. The aim of this symposium is to elucidate the relation between antipsychotics and mortality, including a discussion of the strengths and weaknesses of the studies.”

I do not know how Jimmi Nielsen interpreted the large observational studies of neuroleptics or what he told people at his symposium. But I do know that many leading Danish psychiatrists believe that neuroleptics improve survival and that they usually refer to a deeply flawed Finnish study by Tiihonen et al. in The Lancet (6), which Joanna Moncrieff and I have criticised in our books (2,5). People classified as not taking neuroleptics included those who had recently stopped them, although they are at increased risk of suicide because of withdrawal reactions. In accordance with this, the mortality in patients who were not on drugs was very high and didn’t concur with other Finnish data. There were other fatal flaws in this study, e.g. 64% of the deaths were not accounted for.

The fact is that neuroleptics increase deaths (5), which should surprise no one who is not a psychiatrist. However, it has been abundantly documented that, unfortunately, the psychiatrists prefer to believe in substandard research that supports their false beliefs about neuroleptics as well as other psychiatric drugs (2-5).

Jimmi Nielsen is on the payroll of at least three drug companies, including Lundbeck, which sells neuroleptics and antidepressants (7). He is a great fan of clozapine and believes it can do wonders (7), although a Cochrane review found that it is no better than other neuroleptics (8). As far as I can see, clozapine is worse than other neuroleptics. There were 27 trials with a total of 3099 patients in the Cochrane overview, and clozapine had several dangerous harmful effects. In my opinion, this drug should not be used at all.

Only 12 hours were set aside for symposia in the 2017 programme. It might very well be true that Christiansen’s proposal was turned down because more important issues had been prioritized. I wonder, however, whether it played a role for this decision that I was one of the suggested lecturers. As I have described in my first blog, a professor of psychiatry tried to prevent me from conducting my first course on withdrawal of psychiatric drugs by sending a complaint to the Patient Safety Board.

In his introduction to the proposal, Christiansen mentioned that Professor Emeritus Poul Munk Jørgensen, an honorary member of the Danish Psychiatric Association, held an honorary lecture at the Society’s 2017 annual meeting where he emphasized that psychiatrists, as a professional group, needed to communicate with me. Christiansen also noted that I am one of the founders of the International Institute for Psychiatric Drug Withdrawal, established in 2017 in Göteborg; that we have held the first withdrawal courses, both in Sweden and Denmark; that we have established a major international network; and that we do scientific research on psychiatric drug withdrawal at the Nordic Cochrane Centre and have a PhD student who works on this.

Few psychiatrists know how to withdraw psychiatric drugs safely and effectively. They often do it much too quickly and then conclude that the patients still need the drug because they interpret abstinence symptoms as disease symptoms (2-5). I therefore very much hope that we will be on the programme for the 2019 annual meeting. At any rate, we will continue with our own courses, and psychiatrists are most welcome to turn up.

I have noticed that, as mainstream psychiatry moves from organised denial to outright resistance against any reforms aimed at saving the brains and lives of patients, an increasing number of psychiatrists are questioning their specialty’s many dogmas and falsehoods and are prepared to speak out even though it can endanger their careers. We must support these psychiatrists as much as we can.

 


1. Breggin P. What Should We Really Call Psychiatric Drugs? Mad in America 2018; 17 Jan.

2. Moncrieff J. The myth of the chemical cure. Basingstoke: Palgrave Macmillan; 2008.

3. Breggin PR. Brain-disabling treatments in psychiatry: drugs, electroshock, and the psychopharmaceutical complex. New York: Springer; 2008.

4. Whitaker R. Anatomy of an epidemic. New York: Broadway Books; 2015.

5. Gøtzsche PC. Deadly psychiatry and organised denial. Copenhagen: People’s Press; 2015.

6.Tiihonen J, Lönnqvist J, Wahlbeck K, et al. 11-year follow-up of mortality in patients with schizophrenia: a population-based cohort study (FIN11 study). Lancet 2009;374:620-7.

7. Rebsdorf G. Psykiater får penge fra medicinalindustrien. 2017; 3 Dec. .

8. Asenjo Lobos C, Komossa K, Rummel-Kluge C, Hunger H, Schmid F, Schwarz S, Leucht S. Clozapine versus other atypical antipsychotics for schizophrenia. Cochrane Database Syst Rev 2010;11:CD006633.

 

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