On Your Mind | Robert Whitaker | Antidepressant Effectiveness

 

Think antidepressants are a guaranteed cure for depression? Think again. This episode exposes a hoax: the major study of The STAR*D, touting the effectiveness of antidepressants, was riddled with fraud and protocol violations. Join Robert Whitaker, award-winning journalist and founder of Mad in America, as he dissects this scandal and its impact. We dive into the web of financial interests and potential conflicts of interest that influenced the research, and discuss how this deception has shaped public perception and potentially harmed countless patients. Discover how Mad in America is fighting for a more transparent and holistic approach to mental health, challenging the pharmaceutical industry’s grip and empowering individuals to take control of their well-being.

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Robert Whitaker Talks About The Hoax Of The STAR*D Study On Antidepressant Effectiveness

Robert Whitaker is the author of 4 books and co-author of a 5th, three of which tell of the history of psychiatry. In 2010, his book, Anatomy of An Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness, won the US Investigative Reporters and Editors Book Award for Best Investigative Journalism.

Robert, thank you for joining us.

Thank you for having me. It’s a pleasure to be here.

Mad In America

It’s a delight to see you again. I know that we talked a few years ago. We talked about both of your books and the Mad in America website. I thought it’d be great to get together and get a little update about what’s happening with Mad in America over the past few years and what you’re passionate about these days.

The biggest thing is Mad in America website has continued to grow in two ways. First of all, the number of people that read us. In 2023, we had about 6 million unique visitors over the course of the year, which is about 500,000 a month. We seem to be growing about 10% a year. In terms of our reach into the audience, that’s continuing to grow.

Our podcasts have been downloaded over 1 million times, and we’ve interviewed more than 200 people. That tends to reach a more professional audience, which is great. We’ve standardized our science coverage. We have science pieces four days a week. What our team of science writers do is they review publications and peer review journals that counter the conventional narrative, That’s why they’re never promoted to the public. It might have to do with long-term outcomes or lack of efficacy in trials when you analyze the data, stories about research on whether there have been findings of genes as causal agents in psychiatric disorders, and that sort of thing.

You can go to our site and review our science archives. You’ll find an amazing resource for keeping up-to-date on various themes that are so essential to psychiatry. We’ve continued doing what we’re doing and expanding. We’ve done more of what we call MIA reports, which are some investigative reports. We did receive a big grant from the Soros Foundation to fund that effort for three years.

We always had blogs, personal stories, and science news. We use this money or this funding that we had, which is gone, to do more of our own journalistic reporting. That’s where we do some investigative pieces. I mentioned the Star*D trial scandal to you before we went on the air. We can talk about that. That’s an example of some of the reporting we have done.

The bigger thing is the growth of what we call our affiliate network. It’s branded as Mad in the World. We have affiliate sites in 15 countries and soon to be 17 countries. For example, we had a report from Mad in Ireland about the shutting down of the Irish Open Dialogue effort even though a review found it to be successful.

We have all these affiliates. We had a meeting of all the affiliates in Denmark a few months ago, and it was amazing. We had editors from fifteen countries, 45 were people there with both a shared mission of rethinking psychiatry and what we know, and what narratives societies could organize themselves around that might be more helpful than our disease model narrative.

We are sharing information. We’re running reports from our affiliates. Our affiliates are running our science news and some of our reports. It has become this larger network, almost like an associated press that operates and brings news from abroad to our readers and our coverage around the world. We have an affiliate in India. We have one in Mexico. We have one in Brazil. We have a number throughout Europe.

In the growth of the affiliate network, what you’re seeing is a grassroots movement in country after country saying that the disease model that we have organized our thinking around for the past 40 years has failed. It hasn’t reduced the burden of mental illness. It hasn’t produced an individual to better and long-term outcomes. It’s time for society to rethink that model of care.

This is a final note. I wrote Anatomy of an Epidemic in 2010. That book looked at what is the evidence regarding how psychiatric drugs affect long-term outcomes. We started Mad in America in 2012 to continue this coverage of this scientific literature. The narrative has dramatically changed in the last twelve years, and in part because of Mad in America.

On Your Mind | Robert Whitaker | Antidepressant Effectiveness

Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness

In 2012, it was seen as heresy to say that, for example, antipsychotics haven’t proven to provide a long-term benefit. You have acknowledgments within the research literature that there’s no evidence that they provide a long-term benefit. You even have some leading psychiatrists saying, “We need to rethink the use of these drugs. Maybe they should be used mostly short-term and as low doses as possible.” That was heresy 10 or 12 years ago. Now, it’s seen as a valid concern.

Let’s say, for example, diagnoses. In the ‘90s and the early 2000s, we kept hearing, “It has been established that these are diseases of the brain. Depression is a disease of the brain. Schizophrenia is a disease.” We heard the chemical imbalance story, and that story was a story of great medical progress. Researchers have identified the cause of depression. It was this molecule called serotonin, and they could fix that.

If that chemical imbalance story was true, it would be the greatest medical advance in the history of medicine, given how complex the brain is, and they could identify the molecule that caused depression or madness and they can fix it. That story had already fallen apart in the research literature long before the 2000s, but it kept being promoted to us. The reason it fell apart is that they never found that people with depression had low serotonin. They never found that people with schizophrenia, as a matter of course, had overactive dopamine systems. That fell apart in the ‘90s, but they kept on telling that false story to us.

You see everybody saying, “That story did fall apart.” They blame it on psychiatry and pharmaceutical companies for telling it. I’m talking about psychiatrists, etc. That’s a big change. It’s creeping under the public that the drugs fix any known abnormality. Finally, you look at leading psychiatric researchers, including those who’ve helped make the DSM or created the Diagnostic and Statistical Manual, and they’re all saying that we didn’t validate these disorders as real diseases. They’re saying that these are constructs, and maybe they help us talk about things. That is a shift away since we know that these are diseases in the brain.

What you see in research circles of that whole story of identifying chemical imbalances, much better drugs that were safe and effective in treating those medical imbalances, and things that show that these were genetic disorders and have been validated as real diseases of the brain, that whole story has completely fallen apart and no one is trying to defend it. They’ll say, “We’re moving forward to new ideas.”

The very fact that the old story has fallen apart means that there is an opportunity for society to get involved in what should be the new narrative. What is science telling us? What does the literature tell us? What does our personal experience tell us about why we have difficulties and how we can often surmount those difficulties? We’re at a time of opportunity here for what is usually called a paradigm shift in thinking or the narrative.

Drugs And Mental Health

You asked about Mad in America. We have a role in that. There are two things. There were publications in the past few years by the World Health Organization calling for a revolution in thinking and a revolution in care away from the disease model, and also by the United Nations Special Rapporteur for Health. They relied on our reporting for a lot of what went into their reports. In other words, what we had written about and what science we had revealed. They hired some of our writers to be consultants when they were preparing these documents. That’s an example of how this little organization is having a bigger impact.

I see at the clinical level that it’s seeping into people’s conversations about, “I don’t want to go on meds unless I have to. The doctor on the first visit gave me 2 or 3 prescriptions, and I haven’t even filled them yet.” At a grassroots level, it’s starting to come up that people are questioning, “Do I need to take medicine for this?”

That’s profound because there was a big effort to educate the public going back to the late ‘80s and 1990s when it was like, “You do need to take medication because you have a chemical imbalance.”

Was it Time Magazine or Life Magazine where Prozac was on the cover?

Was it Time and Newsweek that put Prozac on the cover? The breakthrough medications. This is what you’re saying that you’re seeing at the grassroots level. Patients are no longer buying that story necessarily of “I have to take the drug. It will fix me.” They’re understanding that the drug isn’t a fix or not a long-term fix. That’s a good sign that patient ideas, interests, and demands do help change care. If you’re not giving them what they want, if they no longer believe in that, they’re going to have to adjust what they do. It’s great to hear that more patients are saying, “Maybe drugs aren’t the answer.”

The drug isn't a long-term fix. Click To Tweet

There are people like Brook Siem who come out and write about it. She is a very bright and creative individual who’s on 2, 3, or 4 medications and is still suicidal. She says, “Before I take my life, let me experiment with getting off these meds and see what happens.” I see more people who are in that dilemma. The frustration that comes when they’re on one or more meds and they go back to their doctor saying, “This isn’t working,” and they leave with another prescription or two.

Brooke’s story’s important too because she’s questioning why she was put on these drugs in the first place. If I remember her story, her father died or something.

She was fifteen years old. She was close to her father, and he died very precipitously. She’s a very creative person. The episode that she had of her creativity might have happened even if her father hadn’t died. Her mother got freaked out by something that she experienced, and the next thing you know, she’s in the hospital and forced to take meds.

Fifteen years later, she’s struggling to function, but she’s still functioning. She’s running a business in New York, etc., and still feeling suicidal to the point of thinking of jumping out the window to her death. She finally realized as the screen was out of the window, etc., “There’s a medicine cabinet full of drugs that I’m already taking. What would happen if I didn’t?” Something shifted in her.

She decided to explore getting off of those before deciding she could always end her life later. It’s a wonderful book and a well-written story. In the interview I did with her, I told her, “One of the problems with your book is you’re such a good writer that people could get swept up in the story and miss that critically important message about the drugs, the mental health challenges, how perception is shifted by the meds that you take, etc.”

It’s not that maybe the medications aren’t helpful. There is more recognition that people are seeing, “Maybe it’s the drugs that were making me worse. Maybe that’s why I am continuing to have symptoms and feeling depressed, anxious, or whatever.” It’s also a recalibration of what happened to them, not that they didn’t get better on them. Maybe the reason Brooke is suicidal is because of the drugs.

I was having a problem, not necessarily Brooke. Maybe I’m depressed. Maybe I have high anxiety. Maybe I’m having a hard time telling the difference between the reality that I’m experiencing and what other people around me experience. The answer isn’t, “You don’t have enough serotonin. You don’t have enough of this drug or the combination of these two drugs. Everybody else is on these drugs and they’re fine.” It doesn’t work that way.

We know there are these aspects of life. If you talk to one of the functional medicine people, Dr. Mark Hyman says, “It’s not rocket science. What it takes to have a healthy, inspired, productive, and joyful human life is not just food, shelter, and enough money. It’s a sense of purpose. It’s this connection to the community. It’s a sense of love in your life.” You help people work into those various aspects of their lives, and all of a sudden, problems start to get resolved.

Problems, your mood, your sense of self, and everything starts to be resolved. The thing that’s amazing to me is that we got DSM three in 1980, the 3rd edition, and they said, “The environment doesn’t matter. It’s all in these chemicals in your head.” What’s amazing to me is they were able to sell that story even though everybody knows it’s not true. Every human being knows it’s not true.

You know that you’re responsive to your environment. We know that if we lose a job or someone dies, or we’re in unhappy relationships or a terrible job, it’s not rewarding. We know the times when we’re in environments where we have the things you talk about, meaning, love, purpose in life, and the sense of identity with what we’re doing, that we’re happier. It doesn’t mean we’re not always happy. That’s a false idea. What is amazing to me is that’s what we know from literature. That’s what we know from religious tracks.

On Your Mind | Robert Whitaker | Antidepressant Effectiveness

Antidepressant Effectiveness: Every human being knows you’re responsive to your environment.

 

That’s what we know from life experience.

How did they convince us otherwise? That’s what’s so amazing to me. Somehow they convinced us this experience doesn’t matter.

When you think about it, back in the 1990s, the ACEs study came out. People are going through medical training and becoming medical doctors and psychiatrists with no exposure to the ACE study, the Adverse Childhood Experiences study, and how they demonstrated that it is directly correlated to higher levels of physical, mental, and emotional problems later in life. How do you go through medical training and become a psychiatrist and not even hear about that?

You have very poor training. I know they didn’t. That is such a gap in your training that you’re going to eliminate what happens to children in their early years of life and how that might have long-term formative consequences. It’s mind-numbingly stupid and negligent not to be training psychiatrists and counselors in the ACEs study.

Especially psychiatrists, right?

That’s what I mean. Anybody dealing with people later who are struggling should know about the ACEs study.

The book, The Deepest Well, is written by Nadine Burke Harris. She’s one of those psychiatrists who got all the way through training and is out there practicing as a pediatric psychiatrist with no awareness of the ACE study. Somebody shows it to her and she goes, “How could I be practicing and putting out all these different levels of ages of people on medications without even asking about their trauma history or coping mechanisms for dealing with it?”

I have to confess that I can’t imagine that your training could make you blind to what happens to kids as being important, but that’s what happened. When I was writing Anatomy of an Epidemic, I went to a place in Oakland where they treated kids that were seen as Level 12++ kids, the most disturbed kids in all of California.

The psychiatrist there was a great guy named Tony Stanton. The very first thing he did when the kids came in, and the kids would all come in on 5 or 6 drugs. They couldn’t keep their heads up and stuff and with all these diagnoses, he would spend 12 to 15 hours doing a life story of that child and what happened to them. What was so brilliant is he even investigated what happened to their parents, this whole family milieu.

I don’t know if he was trained in the ACEs study or not, but in essence, he was incorporating that with what the ACEs studies tell us, into the way he was treating his kids. His whole point was that kids need to model their behavior after someone they admire and they want to be loved by. Once he had that, his whole thing was, “I’m going to give them mentors,” and a lot of these kids came from impoverished backgrounds, etc., “Someone from their ethnic milieu they could respect, relate to, and want to be loved by and also be appreciated by.”

Kids need to model their behavior after someone they admire and they want to be loved by. Click To Tweet

The other thing that was so important here is once he did the life stories, they stopped talking about the kid as having schizophrenia or the kid having bipolar. They didn’t see them through that diagnostic lens. They saw them through a kid that was beaten, tied to a radiator, sexually abused, and that sort of thing. That’s what the ACEs study is informing us. If they’re in an environment where they don’t feel safe and they feel abused, bullied, and all that sort of thing, parents get divorced, and maybe they lose shelter, that’s going to have a long-lasting impact on that child.

On that person because they grow up. It’s all through their system and in their psyche, all those adaptive mechanisms that probably helped them survive and maintain some level of sanity as a child. They’re seen as completely unproductive and unable to be adaptive. It’s the reverse, they’ve been very adaptive to an abusive environment.

You can comment on this. You know this better than I do. One of the interesting things is they’ve shown how those early adverse experiences change the physiology of the child.

It is why it can correlate so heavily with physical problems, heart disease, diabetes, etc., later in life.

When you put it all together, there’s a causal story there. It’s not just correlation.

I don’t want to talk about the causal because we don’t have proof of it, but we do have the demonstration of a very high correlation.

It’s a very strong correlation if you ask me.

That’s why that study was so impactful for people who cared about what they were doing in trying to help and understand people. There are a number of people who have been out here doing it this way, looking at people as though they make sense. Coherence therapy, for one, used to be called depth-oriented brief therapy. It says whatever’s coming out of a person is for a reason. When you start to help them understand the reasons, usually unconscious and emotionally based, they can find different ways to get those needs met or fulfill those reasons.

There is nonviolent communication, which is Rosenberg’s work. Not everybody’s cup of tea, but he understands and talks about it. He would go into these places, like a psychiatric hospital, and they’d say, “Help us with this person and this diagnosis. Go interview them and tell us what you think.” He says, “I don’t like to diagnose people. I like to talk about what their needs are and how they’re getting those needs met.”

There are a whole host of others that are sprinkled through my experience as a clinician for 50 years. I keep running into these, but none of them have been the prevailing thing that I was trained in or taught. The theory is you go to the diagnosis, you get a treatment plan, and then if the people don’t want to comply with your treatment plan, they’re noncompliant.

They’re treatment-resistant.

Not only that. We don’t say that the patient is treatment-resistant. We say the disease is treatment-resistant. We’re like, “You have treatment-resistant depression.”

Talk about an excuse for the failure of your therapeutics.

The STAR*D Study

It’s silly. There’s high silliness there. I want to come back to what you mentioned about the Star*D. You want to tell us about that. There are a lot of people who won’t even know what you’re referring to, so please start at the beginning, if you will.

This is an important story. My background is as a journalist. I do not understand why the mainstream media hasn’t picked up on this. A story of scientific fraud that had such an impact on our society. The STAR*D study was mounted in the early 2000s by the National Institute of Mental Health. When they mounted this study, here’s what they said, “Our clinical trials conducted by pharmaceutical companies are conducted in a small sliver of patients with depression.” They use inclusion and exclusion criteria that exclude 85% of the real-world patients.

They say in the studies, “We’re going to do the largest and longest antidepressant trial ever conducted to see how our antidepressant care works in real-world patients. This is going to be fundamentally important to how we treat depressed patients. This is going to guide our future care.” First, there was a pilot study in real-world patients, and the results were horrific.

The pilot study and STAR*D are going to try to mimic real-world clinical care. We’re going to get outpatients coming in diagnosed with depression, and the doctors are going to be free, in the first study, to prescribe whatever antidepressant they want. They can change doses. They’re not bound by a protocol. They were like, “It’s not a placebo control. We’re going to see how people do with this form of care.”

I forget the number of patients in the first study. There might have been 100-and-some real-world patients who were moderately depressed. The response rate, meaning a 50% reduction in depression, only something like 25% ever responded to the drug. At the end of one year, only 6% were well and were remitted and stayed well. In other words, the depression was gone.

This was stunning because in studies of non-treated or untreated patients, with the old natural course of depression, the understanding was that you will recover over time. Recovery rates at the end of one year are 85%. That goes all the way back to Kraepelin. All of a sudden, they have a small pilot study, and only 6% are well at the end of one year.

They mount this big STAR*D study. The lead investigator’s name is John Rush. He was the same guy who did the pilot study. Here’s the design. You have to have a HAM-D of fourteen or over to be eligible, which is moderate depression. It’s a little bit more than mild depression, but moderate on that scale of how we measure depression symptoms. They’re going to first be treated with Cymbalta, an antidepressant. If that antidepressant doesn’t work, they can be switched to another one and added to psychotherapy, and then maybe they can be switched to two drugs. They’re going to get four chances to remit.

The protocol says each form of treatment will be twelve weeks. If someone remits at the end of that 12 weeks on a HAM-D score of 7 or below, we’ll put them in a follow-up trial to see if we can keep them well. In the follow-up trial, it’s the same thing. We’re going to pay the people to stay in the trial. You can change doses. It’s going to mimic real-world care.

What was announced was that at the end of four stages of the acute treatment, they say 70% of people remitted. Depression was gone. In essence, they’re cured. That was the message that went out in November of 2006. In that final report, there was also a brief presentation of data from the one-year follow-up to see if you could help people stay well, but they didn’t discuss the outcomes. There’s a table you can’t make sense of. The only thing they say is the percentage of people who remit after each stage becomes less. That’s all they say, that it’s good if people can remit right away.

As early as 2010, a psychologist named Ed Pigott had begun picking apart that study. I reported on Anatomy of an Epidemic in 2010, and I could see the 70% figure wasn’t substantiated. There was all sorts of weirdness to the study. The number of people is said to be a valuable change from the 1st report to the 4th report. They changed the outcome measures from HAM-D to QUIDs, and then they did this crazy thing where they said, “We’re going to imagine if there were no dropouts how many people would’ve remitted during those four stages.”

They were like, “We’re going to imagine that and then report it as though it happened.”

They include that in the report of remitted patients. I concluded based on that that at most, 25% of the patients had stayed well. I couldn’t make sense of the whole thing, and I only had a couple of paragraphs. Ed Pigott began pulling it apart in 2010. He reported that if they had adhered to the protocol, it looked like maybe only 38% had remitted, not 70%.

He managed to figure out the table for long-term outcomes. He found, which was confirmed by the lead investigators when they were confronted, that of the 4,041 patients who entered the study, only 108 remitted and stayed well and in the trial to its one-year end. The other 97% either never remitted, remitted, relapsed or dropped out. Under the protocol, dropouts were supposed to be seen as treatment failures.

Mad in America began reporting on that scandal in 2012. We had a number of reports, but then something happened in 2023 that brought it home, the scandal. What happened was Ed Pigott and his colleagues had finally gotten access to the patient-level data. They had used the freedom of information request, and through a program called the RIAT Act, which is the reanalysis and integration of trial data. Since it was a federally funded study, they were able to get the patient-level data under this act.

What did they find? They’re able to identify the protocol violations that were used to inflate an actual remission rate of 35% to 70%. They talked about how people who were initially medicated and didn’t return for a second follow-up visit were supposed to be counted as treatment failures, but they removed those patients from the number of supposedly valuable patients. That’s number one.

Number two, they switched from HAM-D to this other invalidated measurement called QUIDs, which wasn’t blinded. It was given at every treatment. Their protocol explicitly said, “Do not use this for measuring remission outcomes. Yet, that’s what they used to do. By each one, they’re going to get a numerical account of how this inflated it. We get the not counting of initial dropouts. We get the switch. That was 191.

In the fourth one, they included 900-and-some patients in their final tally who weren’t depressed enough to be eligible for the trial. In other words, they didn’t have an initial baseline score of fourteen or above, including some who scored in remission at the beginning. For some reason, they kept on treating them. If they eventually scored as remitted, they counted them as having remitted.

Even though they weren’t depressed in the first place.

Finally, what they did is, let’s say you go through that first stage of the trial and you don’t remit. You drop out. You’re supposed to be counted as a treatment failure. They said, “If they would’ve stayed in phase two, they would’ve remitted at the same rate as those who did three.” That would add another 600 remissions or something like that.

It’s research fraud. You have criteria that say to be eligible. They didn’t tell us that they were including this. You can’t switch endpoints from a blinded thing to an unblinded one and count that. You can’t make up imaginary people. You have to adhere to the protocol. That got published in the BMJ. It has been established as having validity. Pigott and others did publish theirs in peer-reviewed journals. We have a very high-impact journal that’s saying, “This is the actual results.”

What we did at Mad in America, in a very clear way, even clearer than their initial thing, is we showed the numbers involved in each protocol violation, the specific numbers, and laid out the fraud. We were like, “Here’s the protocol. Here’s what they reported. Here’s the intent.” We put the context, “This is research fraud.” We said, “Once research fraud is known, the American Journal of Psychiatry now has an obligation under the rules of medicine, since rules are supposed to govern journal letters, to retract that study.” We mounted a petition saying, “This study should be retracted.” It was a petition online. We got 2,000 people from 50 countries, including psychiatrists saying, “Retract this study.”

Once research fraud is known, the American General Psychiatry now has an obligation under the rules of medicine to retract the STAR*D study. Click To Tweet

That forced the investigators to pen a reply to the American Journal of Psychiatry. They lied in their thing saying, “We wanted to have an inclusive report of all the people in the study. QUIDs were validated as a real thing. If you read the study, we did admit that it was theoretical.” That’s what they said. They countenance this misleading of the public. Here’s what’s important. When that study came out in 2006, this became the study that the media regularly cited ever since as evidence that antipsychotics cured 70% of people. The message to doctors was, “If the 1st drug doesn’t work, try a 2nd or try 2 drugs.”

Let me correct you because you said antipsychotics.

Antidepressants. I’m sorry. Thank you for correcting that. It was like, “If the 1st antidepressant doesn’t work, try a 2nd and then add it,” etc. It governed our care. Finally, a psychiatric journal stepped up and said, “This is a problem for us.” It was psychiatric time. They said, “This is the study that has governed our thinking in our care for nearly two decades. If this reanalysis is correct, we need to change our protocols.”

Finally, they did run a letter to the editor. Two psychiatrists said, “The excuse given by the investigators is ridiculous. Our profession needs to atone and retract that study. What do you have in this scandal? You have, in the largest and longest trial of antidepressants ever conducted funded by you and me, the National Institute of Mental Health,” or in other words, federally funded, “A study that the results would be rapidly disseminated because they would govern our thinking about how to treat depression.” That was the promise.

The NIMH, when the study’s year-long follow-up results were announced and the remission, said, “This shows that 70% are cured by this drug or this form of treatment. It shows we can get most people well.” It was false. It was fake. In fact, we were being told of a 70% stay-well rate at one year. That was the message from the NIMH. The documented stay-well rate was 3%, 108.

Of that 108, many came from 99 patients who were in remission at the start of the trial. Hardly anyone got better, stayed well, and in care. If that had been rapidly disseminated in 2006, the media wouldn’t have been touting the STAR*D study as evidence of the efficacy of antidepressants every time there is a question about them. They would’ve said that in the largest trial, very few people got well and stayed well.

Our total societal thinking about antidepressants and the use of these drugs would have changed. That’s how profound this was. They lied to us. They mislead us. Even after this has been documented in the British Medical Journal, psychiatry somehow has kept it out of the mainstream media. No mainstream media has picked up the story of fraud. This is why it is so important.

On Your Mind | Robert Whitaker | Antidepressant Effectiveness

Antidepressant Effectiveness: Our total societal thinking about antidepressants and use of these drugs would have changed. That’s how profound this was. They lied to us. They mislead us.

 

We’ve reported three times on it with in-depth reports. You can go on Mad in America and search STAR*D. You’ll see a history of reports about the fraud. It’s stuff since last August 2023 when this reanalysis came out. You’ll see it is documented fraud on the American public that governed our thinking of using these drugs that led people to take these drugs thinking they would be cured or have a good chance of being cured even while the evidence from this trial showed they were very unlikely to get remission and stay in remission.

That is an extraordinary betrayal of the public’s right to know of informed consent and of making life-changing decisions based on false information. That’s why the scandal needs to be known and discussed. We need to know as a public that we were misled in this way by an institution or a medical discipline. That’s why I say it’s the biggest scandal in medicine in a long time.

Is there a way that your reporters and you can conceptualize what might have been the motivating factor?

The motivating factor is quite easy to see, and we’ve written about it. They have two motivating factors in essence. One, even though it was funded by the NIMH, nearly all these investigators were being paid by pharmaceutical companies to be advisors, consultants, and speakers. Part of their income is maintaining a belief in antidepressants. They have that personal time, but they also have a guild interest.

What do psychiatrists mostly do these days? They gave up counseling to other people. What’s their product? Their main products are antidepressants, antipsychotics, benzodiazepines, and maybe mood stimulants. Can they say their most popular drug doesn’t work even after they’ve said it fixes chemical imbalance, they’ve got 15% of the population on these drugs or 20%, and they’re putting kids on these drugs. Can they as a profession admit these findings? The findings are going to cause society to recalibrate their thinking of these drugs. What’s the motivation? It’s quite clear. It’s because they were protecting the image of their product. It’s like General Motors. Do they want to admit their car doesn’t run?

The thing that I wanted you to help clarify, which you did very briefly, is the consultants that were hired by the NIMH were these people who make their living on and are devoted to making sure that medications are seen as effective. It’s not necessarily that our government wants us to stay on these drugs. It’s that the money that’s being made is extraordinarily large and powerful.

We put up a table and we listed all the majors that you can call consultants, but these were the researchers who did the studies.

I was using that word because I thought I heard you use it, the people who were consulting the NIMH.

They were consultants to the drug industry. That’s the point. They were presented as professors of psychiatry to the public at so-and-so or as prestigious people. We did a look at it, Mad in America or I did, about their disclosures. Some of the leading investigators had ties to 25 companies serving on their speakers bureaus. Many of them had ties to the maker of the drug that was first used. You are right. They were consultants to an industry but presented as independent scientists and researchers at prestigious universities. That’s part of the sleight of hand, so to speak. Once you understand that, you can understand the motivation.

The sleight of hand is a very gentle way of saying fraud.

It was a fraud. It caused great harm to people like Brooke Siem and everybody else who then went on the medication with the understanding these were very effective. At this time, they were still saying that they fixed a chemical imbalance. That was medical fraud. In 1999, the American Psychiatric Association’s own textbook said low monoamine hypothesis of depression. Serotonin is a monoamine source as well as norepinephrine. It says, “We have investigated that and it hasn’t panned out,” in their own textbook.

They even said it was a ridiculous hypothesis in the first place because there’s no reason. They said they noticed that the hypothesis was born from an understanding of the mechanism of the action of the drug and not from what was happening in the brains of people with depression. They said, “There’s no reason that the pathology of a disorder is going to be the opposite of a drug you’re using to treat symptoms.” It was a failed hypothesis. That’s 1999.

In 2001, we heard a publication from the APA saying, “We now know that depression is due to too little serotonin.” In 2005, they put out a press release saying that psychiatrists are experts in fixing chemical imbalances in the brain. You could go on their website. The website says that depression is due to too little serotonin.

This is years after they already admitted that it’s a failed hypothesis.

That is talking about the betrayal of the public. You can’t tell a heart patient they have a hole in their heart when they don’t have a hole in their heart. Why can you tell a person who’s coming to you feeling depressed that you know what the pathology is when you didn’t find out it to be so? Why is there a separate standard for psychiatry from other areas of medicine? That’s because if you falsely told a person that you had identified a pathology when you hadn’t,

Also, give them a whole barrage of treatments.

You’d be liable for medical negligence or medical fraud. For some reason in psychiatry, we have these different standards, and for whatever reason, the mainstream media hasn’t picked up on this. I do not know why because the STAR*D study is a huge story. The public would consider it a huge story. They’d be going, “This happened to me. This changed my life.” The New York Times in 2022 pointed to the STAR*D study as having a 70% remission rate, and that proved the drugs were efficacious. That’s in 2022. Why won’t they correct the record? I don’t know.

I appreciate your willingness to keep looking at it and report it. I greatly appreciate the resource of MadInAmerica.com as a website. I greatly appreciate your taking the time to share this with us.

Thanks for having me. As always, it’s great being here.

It’s fabulous that we have people like you who are willing to keep doing the work and talk truth to power sometimes at great expense. Thank you for that. I’ve said the website. It’s MadInAmerica.com. Is there a way if people want to get more involved that we could direct them on the website? Is there a special area?

Learn More

First of all, we do have a resource section. In addition to daily content and that sort of thing, you can go on our site. On the menu bar, there will be something that says Drugs. You do a drop-down and you can go to antidepressants for depression. What you’ll see on that resource page is a concise summary of what the research is, how the drugs act on the brain, what is known about the biology of depression, and the efficacy over the short term. We look at effect sizes and stuff. We’re reporting what’s in the meta-analysis of the antidepressant trials conducted by pharmaceutical companies. We then go over all the long-term studies. The big thing is we also have links to the studies, so you can go back to the original studies.

Finally, for example, with antidepressants, people don’t know this, and it goes back to the 1970s, but by the early 1990s, you do have some researchers saying, “These drugs are increasing the chronicity of the disorder. People are now relapsing more frequently.” You can find links to articles of that sort in an article in 2012 by a well-known mood disorders expert who laid out a biological explanation for why they caused tardive dysphoria.

One of the things we want to give here is the ability for people to go on our site and review the research in a sophisticated way but also in an understandable way for lay people. We also do it for non-drug therapy, so the information we have for treating depression in other ways that have been tested and that sort of thing. There are those resources.

Finally, in terms of getting involved, we have people who submit blogs from all over the world on topics related to this big topic. We also have people submitting stories of lived experience. For example, Brooke. Brooke is coming to work for us as an interviewer for the MIA Radio podcast, Brooke Siem. She’s a very bright woman.

You can go into the About section of MadInAmerica.com and you can see my name there. You can contact me via email, which I’m very good at getting back to people, or you can contact other members of Mad in America. You can submit blogs to us. You can submit personal stories to us. We’ll respond to your emails. That’s the answer. We have art submissions too. People submit art to us as well. We run galleries.

I greatly appreciate your time. I will check in about a year and see how things are progressing.

Thanks. It’s a real pleasure being on your show. It was a nice discussion.

Blessings.

 

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About Robert Whitaker

On Your Mind | Robert Whitaker | Antidepressant EffectivenessRobert Whitaker is the author of four books, and coauthor of a fifth, three of which tell of the history of psychiatry. In 2010, his Anatomy of an Epidemic: Magic Bullets, Psychiatric Drugs, and the Astonishing Rise of Mental Illness won the U.S. Investigative Reporters and Editors book award for best investigative journalism. Prior to writing books, he worked as a science reporter at the Albany Times Union newspaper in New York for a number of years. He is the founder of madinamerica.com, a website that features research news and blogs by an international group of writers interested in “rethinking psychiatry.”

Journey's Dream

Journey's Dream

Used to select this used (Journey's Dream) as Author of the On Your Mind Podcasts

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