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Whitaker, 2016 The case against psychiatric drugs

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This is an article by Robert Whitaker recently published in the Brazillian Journal of Mental Health


Source:  Cadernos Brasileiros de Saúde Mental/ Brazilian Journal of Mental Health ISSN 1984-2147, Florianópolis, Santa Catarina, Brasil.


Title:  The case against psychiatric drugs


Author:  Robert Whitaker


Link -  (can access a full text PDF via this link)




ABSTRACT The conventional narrative in psychiatry tells of a psychopharmacological revolution that began with the arrival of chlorpromazine in asylum medicine in 1955. Today, psychiatric drugs are understood to be safe and effective treatments for a variety of disorders. However, a close review of the scientific literature, stretching over a span of 50 years, reveals a paradox: medications that are effective over the short term may increase the chronicity of a disorder over the long-term. A case study of antipsychotics best illustrates this paradox. The small number of researchers investigating this paradox are focusing on drug induced “oppositional tolerance” as an explanation for the poor long-term outcomes of medicated patients.

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Great find dalsaan.

Thanks for posting.

Wonder if this has been published in an English Journal as well.

I think a miracle has happened ....i seem to be able to understand Portuguese!

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In 1987, the year that Prozac was approved for marketing, there were 1.25 million adults in the United States receiving an SSI or SSDI payment due to a mental disorder. This produced a disability rate of 543 per 100,000 people. Since that time, the number of adults on government disability due to a mental disorder has risen to more than 4.5 million in 2014, a disability rate of 1,408 per 100,000.
Thus, during the Prozac era, the disability rate has nearly tripled in the United States.

The same sharp rise in disability due to mental disorders has occurred in country after country that has adopted widespread use of psychiatric drugs. Australia, New Zealand, Canada, United Kingdom, Iceland, Denmark, Sweden and numerous other countries have reported similar sharp rises in disability due to mental disorders.


All of which raises a question, which is the focus of this paper: Do these drugs help people stay well, or, for some paradoxical reason, do they worsen long-term outcomes and thus increase the risk that a person suffering from a psychiatric disorder will end up disabled by it?

pg 3


But this is not the end of this scientific story. Research into the chemical imbalance theory of mental disorders did bear fruit in one way: it helped flesh out an understanding of how the brain is changed by a psychiatric drug. And what the researchers found is that a psychiatric drug, in essence, creates the very chemical imbalance hypothesized to cause the disorder in the first place.



Prior to the antidepressant era, depression was understood to be an episodic disorder. But once antidepressants began to be commonly used, at least a few psychiatrists began to worry that the drugs were causing a “chronification” of the disease, and numerous studies have since found that depression runs a much more chronic course today than it did before the advent of the drugs. In addition, long-term studies conducted during the past 20 years have regularly found that the unmedicated patients have better outcomes. These findings have led to the worry, first expressed by Giovanni Fava in 1994, that antidepressants induce a biological change in the brain that increases a person’s biological vulnerability to depression.


In a review of this question, Rif El-Mallakh, an expert in mood disorders from the University of Louisville School of Medicine, concluded that SSRI antidepressantscould induce a chronic depressive state he called tardive dysphoria. “Continued drug treatment may induce processes that are the opposite of what the medication originally produced,” he wrote. This may “cause a worsening of the illness, continue for a period of time after discontinuation of the medicine, and may not be reversible.”

This problem of oppositional toleranceis likely a universal one with longterm use of psychiatric drugs. The drugs induce compensatory adaptations in the brain that are the opposite of theirintended effect. Long-term outcome studies of other psychiatric disorders provide additional reason to worry that this might be so. Over the long-term, benzodiazepine users are likely to experience an increase in anxiety symptoms. Long-term outcomes for bipolar patients have notably deteriorated in the last forty years. Studies of stimulants as a treatment for ADHD have failed to find that the treatment provides a long-term benefit




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