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GentleSteps

"Lost Connections" by Johann Hari

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GentleSteps

This book looks to be an interesting read, on depression, anxiety, the DSM diagnostic model, critiques of the "chemical imbalance" theory and the actual (in)effectiveness and even harms of antidepressants.

 

This link is to interview clips on the book's website.  Among the interviewees: Dr. David Healy, Joanna Moncrieff, John Joannides, Prof. Irving Kirsch and Dr. Guy Sapirstein (meta-study re antidepressants as/less effective than placebo) and defenders of SSRIs like Peter Kramer as well.  https://thelostconnections.com/the-interviews/

 

I haven't heard of Hari but he is described as a "best-selling NY Times author."  It will be interesting to see the effect of views familiar to many on SA ripple to this author's presumably quite wide audience.

 

Discovered after I read the book's website that Hari has a bit of a history as a journalist - plagiarism got him fired from a job as a columnist not too long ago, among other issues.  Relevant article from The Guardian here: https://www.theguardian.com/media/2015/jan/02/johann-hari-interview-drugs-book-independent.

 

 

 

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Kristine
16 minutes ago, GentleSteps said:

Johann Hari: a brief interview with Tucker Carlson (Fox).  Except for Carlson making an off-hand remark that "well, there are some chemical imbalances" it's good to see Hari's book receiving wide publicity.

 

(Hat tip to BB, where I found this.)

https://www.youtube.com/watch?v=89kSjxm_MQM&list=PLlTLHnxSVuIzrARlmz9oCfQEF08UV-v-E&index=2

 

Excellent, GS...couldn't agree more! Think I'll have to buy his book! Thank you for posting this. K xo

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Shep

I read the book and would highly recommend it, however, not to everyone. This book doesn't go anywhere near the level of expertise of the harm these drugs cause as say, Robert Whitaker (Hari is a social investigative reporter not a science reporter like Whitaker).  And, in some ways, Hari comes across as an apologist for big pharma and psychiatry because he says he doesn't have anything against ADs and says "we should keep them on the menu of ways to deal with depression". 

 

So if you're interested in a book that validates your own experience with withdrawal and want to focus exclusively on that aspect, you may find this book a frustrating read - it's only 10% on the drugs and 90% on alternatives. He provides a list of the things that can cause depression but the iatrogenic aspects (i.e. harm caused by the drugs themselves) are completely left out.

 

That being said, the book is a great read for the social and political aspects of this epidemic. The book is very powerful and not only has Hari appeared on Fox (the link that GentleSteps got from Benzo Buddies), but he's also appeared on Democracy Now. He may be the first investigative reporter to appear on both a right-wing conservative news show and a left-wing progressive news show saying that the chemical imbalance theory of antidepressants is a lie. 

 

And for that, he deserves recognition. In a very politically polarizing world, he has brought this truth to both sides, proving a great point he makes in the book - we are all in this together.

 

Here's his Democracy Now interview, which went longer than the show, so Amy Goodman added a second part. Very much worth a look. 

 

Democracy Now - Johann Hari on How the “Junk Values” of Neoliberalism Drive Depression and Anxiety in the U.S. - PART ONE

 

Democracy Now: Johann Hari: To Treat Depression, Provide Meaningful Work, Housing & a Basic Income, Not Just Drugs - PART TWO

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GentleSteps

Hi Shep,

 

Thank you for posting the links to Amy Goodman's interview!

 

It is heartening to see Hari's point that community and connection are the real antidotes to depression receiving coverage across the spectrum of the mainstream media.

 

His is quite a radical challenge to the atomistic ("it's all down to individuals") models that underpin the strategies of Drug Companies and Psychiatrists, and the economic-political system that thrives on this atomization.

 

I heard recently that Thich Nhat Hahn said that the next Buddha (after Maitreya) will be Sangha.

 

It's always wonderful reading your insightful and incredibly well written posts Shep.

 

Thanks again,

 

GS  

 

 

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Shep
19 hours ago, GentleSteps said:

I heard recently that Thich Nhat Hahn said that the next Buddha (after Maitreya) will be Sangha.

 

Thanks for continuing to add to this thread, GentleSteps.

 

I wasn't sure what this meant, but I was curious so I looked it up:

 

The Next Buddha Will Be a Sangha..

 

The only Tibetan thangka that I own is one of Maitreya – the future Buddha.  The basis of Kalachakra Tantra is the notion of an enlightened society.  Vidyadhara said that Maitreya, the future Buddha, would not be an individual, but a society.

Thich Nhat Hanh did a calligraphy that says in English:  THE NEXT BUDDHA WILL BE A SANGHA.

 

This is a beautiful thought and right in line with what Hari is saying.

 

If you haven't read his first book, Chasing the Scream: The First and Last Days of the War on Drugs, it's a great read. Here's Hari's TedTalk about it:

 

Johann Hari - Everything you think you know about addiction is wrong video (15 minutes)

 

We are definitely in need of a Sangha. 

Edited by Shep

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GentleSteps

Ah - thank you for looking up the source and finding the accurate reference ... that Maitreya will be the Sangha Buddha.  It's a beautiful quotation.  I am so happy you found it and offered it up!

 

Yes, we are in need of a Sangha (or Sanghas) - a broad one that reaches beyond a meditation cushion or hall.

 

Thank you for the reference to the previous book by Hari.  It is on my reading list for a time when I'm able to absorb the painful content with more equanimity! 

 

GS

 

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TikkiTikki

I've been reading the book and find it very helpful – the idea that many experiences of depression and anxiety are a natural response to psychological needs being unmet is I think very powerful. That some of us have a greater genetic or biological susceptibility or reactivity to these social/psychological factors – I also concur.

 

I've long thought depression/anxiety are a fairly rational response to modern life and the modern world, and Hari's book details the how and why of it. 

 

 

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Shep

From the Mad in America site:

 

Johann Hari Continues to Speak Out

 

Johann Hari, British journalist and author of the new book Lost Connections: Uncovering the Real Causes of Depression—and the Unexpected Solutions, continues to speak out about the social and systemic factors impacting our mental health. Click below to read and watch some of his essays and videos from the past two months.

Screen-Shot-2018-02-22-at-10.29.22-AM-e1

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Downbutnotout
On 2/11/2018 at 10:05 PM, Kristine said:

Excellent, GS...couldn't agree more! Think I'll have to buy his book! Thank you for posting this. K xo

Interesting. 

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GentleSteps

Thank you for continuing this thread, Shep.  I am watching with great interest how this book is rippling far and wide. (*)

 

One of your links - "Johann Hari Takes Issue with the Concept of Self-Help" - is a wonderful short essay that amplifies our exchange earlier on the importance of Sangha for finding connectedness and happiness (following on Hari 's focus on connection being the antidote to depression).  In contrast to the individualistic (and isolating) "self-help" model prevalent in America and the West.  It's a great read.  He concludes by suggesting that instead of putting his book in the self-help sections of bookstores those sections should be (paraphrasing) sectioned-off and eliminated!

 

(*) I've been wondering if it's a coincidence or not that UK media just published with great fanfare the results of a meta-study looking at dozens (hundreds?) of SSRI studies and concluding, in essence, that "ADs Do Work and More People Should Be on Them."  (Not one of the studies under review was longer than 8 weeks, of course.)

 

My first thought was - interesting timing, right after the Hari book has been getting such extensive public coverage.  Fiona has been at the forefront of the push-back .  It's turning into a very interesting story, with the Royal College of Psychiatry publishing (and then quickly removing - after protest from doctors and Fiona) a leaflet stating that withdrawal from AD's only takes a couple of weeks.  There's a long thread on this over at BB.  I may start one here, transferring some of the highlights.

 

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GentleSteps
1 hour ago, GentleSteps said:

It's turning into a very interesting story, with the Royal College of Psychiatry publishing (and then quickly removing - after protest from doctors and Fiona) a leaflet stating that withdrawal from AD's only takes a couple of weeks.  There's a long thread on this over at BB.  I may start one here, transferring some of the highlights.

 

Correction.

The story is actually that: Prof. Wendy Burn at the Royal College of Psychiatrists (RCP) made a public statement in the wake of The Lancet's publication of a meta-study led by a Dr. Cipriani (120,000 patients in pharmaceutical company AD trials, none longer than 8 weeks - conclusion: ADs work!)  that in her clinical experience withdrawal symptoms only last about 2 weeks.  Big mistake!  It turns out that the RCP has a leaflet (posted on its website) on withdrawal from ("coming off of") ADs that stated withdrawal symptoms could last anywhere from 2 weeks to months, or longer.   As persons posting to Dr. Burn's twitter feed pointed out that the RCP leaflet contradicted her statement, Fiona noticed that the leaflet had "disappeared" from the RCP website (as Fiona put it "well, the leaflet has come off!").

 

Fiona, James Moore, someone with the handle "Consultant" and others take Dr. Burn to task with cordiality but great verve.  Dr. Burn has now stated in the same twitter thread that the withdrawal "leaflet was out of date" (2014) and that it is under revision.  She acknowledged that James Moore has volunteered to be on the revisions committee and agrees that patients must be involved in the process.  

 

Here is the link to the Twitter thread.  https://twitter.com/wendyburn/status/968209621595942912

 

Fiona, James et al. are doing a wonderful job of publicly raising the issues of SSRI effectiveness safety, duration of use, and of course, withdrawal.  Fiona notes too that the 2014 "coming off" leaflet had asked for feedback - she asks Dr. Burn where the feedback is.  Dr. Burn says she'll look for it, but Fiona has her feedback document at the ready and posts it right on the Twitter thread.    

 

The person with the handle "Consultant@medconsult" quotes Dr. Burn's statement about withdrawals lasting just about 2 weeks and responds:

“What I said based on my clinical practice where coming off antidepressants honestly has not been a big problem for my patients” Do you live in a different world? Please share the secrets of your success @wendyburn

consultant added,

recovery&renewal @recover2renew [FIONA'S HANDLE]
Unbelievable! https://twitter.com/wendyburn/status/967164376967983104 
1 reply0 retweets3 likes
 

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Shep
7 hours ago, GentleSteps said:

My first thought was - interesting timing, right after the Hari book has been getting such extensive public coverage.  

 

Yes, I think it was interesting timing, too. I was a bit critical of Hari's book because it gave too little information on the drugs and didn't mention iatrogenic damage as one of the reasons for depression, but I think Hari was smart to simply open the door to discussion.

 

And now having this populist political take on it out there, I'm sure the RCP is very nervous about a massive public backlash. 

 

But the RCP is extremely aware of the dangers of psychiatric drugs. This is Dr. Moncrieff's exchange with the RCP over the fact that long-term treatment with antipsychotics causes brain damage: 

 

Royal College of Psychiatrists still not interested in discussing important evidence on long-term antipsychotic treatment

 

So they are well aware of long term damage of the antipsychotic but refuse to address it and deal with it. So it's the same thing playing out with the antidepressant. 

 

Sadly, the antipsychotic is now being used as an "add on" treatment for "treatment resistant" depression, so millions of people are now dealing with both drugs. 

 

6 hours ago, GentleSteps said:

Fiona, James et al. are doing a wonderful job of publicly raising the issues of SSRI effectiveness safety, duration of use, and of course, withdrawal.  Fiona notes too that the 2014 "coming off" leaflet had asked for feedback - she asks Dr. Burn where the feedback is.  Dr. Burn says she'll look for it, but Fiona has her feedback document at the ready and posts it right on the Twitter thread.    

 

Thanks for continuing to follow this and post about it, GentleSteps. I follow James and Fiona on Twitter and yes, they are doing a wonderful job.

 

7 hours ago, GentleSteps said:

There's a long thread on this over at BB.  I may start one here, transferring some of the highlights.

 

Please feel free to do so. You may want to add it to the thread on SA discussing the study.  Vanora has made a post listing all of the psychiatrists and doctors who are fighting back in her post here so please continue adding on information. The more the better. 

 

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NewportAcademy

This is such an important topic and one we're happy is getting exposure. Here's a response piece from the perspective of one of our senior clinicians: http://bit.ly/2FTkI1F   

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Bonzee

I'm not sure the claim that SSRI's are not anymore effective than placebo is accurate, but I agree most people probably don't need them. There is definitely something physiologically changing in the brain when an SSRI is introduced, and depression/anxiety is markedly reduced as a result. The problem is doctors still have no definite idea how SSRI/SNRI/Tricyclics/Buspirone/Bupropion, etc. work... we know about SERT transporters, and reuptake, but this is a theory that cannot be proven. Who knows what it does to the brain.

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ChessieCat
4 minutes ago, Bonzee said:

I'm not sure the claim that SSRI's are not anymore effective than placebo is accurate

 

4 minutes ago, Bonzee said:

There is definitely something physiologically changing in the brain when an SSRI is introduced

 

I agree with the second quoted comment.

 

Are you aware of that a company only needs to submit 2 trials but cane do as many as they want to?  Irving Kirsch and his cohorts obtained clinical trials data through Freedom of Information.  This video is very good.  Even if you aren't sure about the claim that SSRI's are not anymore effective than placebo it is an eye opener about data collection and the trials used to get drugs on the market.

 

Video:  Irving Kirsch:  Emperor's New Drugs:  Antidepressants and the Placebo Effect (1 hour 20 minutes)

 

 

Approval Criteria Used by the FDA

Antidepressants and the Placebo Effect by Irving Kirsch (link to full article)


Abstract:

Antidepressants are supposed to work by fixing a chemical imbalance, specifically, a lack of serotonin in the brain.  Indeed, their supposed effectiveness is the primary evidence for the chemical imbalance theory.  But analyses of the published data and the unpublished data that were hidden by drug companies reveals that most (if not all) of the benefits are due to the placebo effect.  Some antidepressants increase serotonin levels, some decrease it, and some have no effect at all on serotonin.  Nevertheless, they all show the same therapeutic benefit.  Even the small statistical difference between antidepressants and placebos may be an enhanced placebo effect, due to the fact that most patients and doctors in clinical trials successfully break blind.  The serotonin theory is as close as any theory in the history of science to having been proved wrong.  Instead of curing depression, popular antidepressants may induce a biological vulnerability making people more likely to become depressed in the future.

Excerpt:

How Did These Drugs Get Approved?
....
The FDA requires two adequately conducted clinical trials showing a significant difference between drug and placebo.  But there is a loophole:  there is no limit to the number of trials that can be conducted in search of these two significant trials.  Trials showing negative results simply do not count.  Furthermore, the clinical significance of the findings is not considered.  All that matters is that the results are statistically significant.
....
(NB:  emphasis in abstract and excerpt are mine)

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Bonzee

Hi Chessie,

 

Yes, I agree these drug companies do try to stretch the trials, and many do not study the long term effects of AD, to get a fast path to approval. I'm going into the medical field, and from my experience I run into problems calling these drugs placebo pills, mainly because of two reasons:

 

1. A placebo effect would work immediately, and most antidepressants have been studied in which conclusively, at least 1 week must be given before therapeutic effect is reached.

2. Placebo effect would not explain why some drugs (of the same class) are more effective than others in relieving symptoms.

 

Just my two cents, not defending...just want to stay logical as much as possible. 

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Shep
On 4/8/2018 at 10:51 PM, Bonzee said:

1. A placebo effect would work immediately, and most antidepressants have been studied in which conclusively, at least 1 week must be given before therapeutic effect is reached.

 

I've had similar questions about the placebo effect, as well. But from my understanding, if you expect a delay in the drug working, that would play into the placebo effect. Since more people are aware that antidepressants don't take effect immediately (direct to consumer advertising may play a role in this), it could explain a placebo effect delay.

 

On 4/8/2018 at 10:51 PM, Bonzee said:

2. Placebo effect would not explain why some drugs (of the same class) are more effective than others in relieving symptoms.

 

 

Even though the drugs may be of the same class, there are variations in half lives, potency, onset of effect, etc. that can all play a role in how the drug effects the person taking it. 

 

This is especially important to consider because the effectiveness depends on what the researchers are looking for. For instance, some research is for the efficacy in the treatment of depression, some research is for anxiety, some research is for panic disorder, etc. Prozac has a slower onset of effect and therefore is considered less effective for anxiety disorders. 

 

There are also variations in the placebo group and their expectations. Variations such as gender, culture, and ethnicity all play roles. Even though the research may be for the same class of drugs, the people vary. There are studies that show variations in how men and women experience the placebo effect, as well as the nocebo effect. Same for different cultures.

 

These are very general concepts, but without knowing which studies your are referring to, I can only speak in general concepts that might explain why some drugs of the same class are more effective than others in relation to the placebo. 

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Bonzee
2 hours ago, Shep said:

Even though the drugs may be of the same class, there are variations in half lives, potency, onset of effect, etc. that can all play a role in how the drug effects the person taking it.

Hi Shep!

 

Thanks for the reply. I agree with most of your assessments regarding this topic, but I would add that a placebo must be devoid of any ability to cause any effective change in the body whatsoever. So, if you claim the reason why variations in medication of the same class is due to potency, onset of effect differences, and variations in half life, this would not be a placebo and would indeed be a change agent (or medication). I just want to highlight this point because I don't want people to be confused and think an SSRI is a placebo pill, if this were true the differences you listed would not be relevant.

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Shep
12 minutes ago, Bonzee said:

Hi Shep!

 

Thanks for the reply. I agree with most of your assessments regarding this topic, but I would add that a placebo must be devoid of any ability to cause any effective change in the body whatsoever. So, if you claim the reason why variations in medication of the same class is due to potency, onset of effect differences, and variations in half life, this would not be a placebo and would indeed be a change agent (or medication). I just want to highlight this point because I don't want people to be confused and think an SSRI is a placebo pill, if this were true the differences you listed would not be relevant.

 

I enjoy these kinds of discussions, too. 

 

Regarding your comment that  "a placebo must be devoid of any ability to cause any effective change in the body whatsoever."  Keep in mind that the research Kirsch wrote about involved "active placebos". An active placebo will indeed effect change in the form of side effects. 

 

Active placebo definition - "a substance used in controlled experiments (such as a double-blind study of a drug) that has no therapeutic effect on the condition being treated but may produce side effects (such as drowsiness or nausea) similar to those of the substance whose effectiveness is being tested."

 

 So, for example, the sedation from an active placebo could actually help someone with depression - we all are aware of how much we are affected by sleep. So Kirsch took all of this into consideration in his SSRI placebo discussions (for more, please see his book - The Emperor's New Drugs: Exploding the Antidepressant Myth).

 

I agree with you on not saying that the SSRI - or any other pill in this kind of research - is a "placebo pill". I think that's an over-simplification of a very complex issue. This is especially true with psychiatric drugs because these drugs don't fix a disease, they simply medicate a symptom. And there are no tests (blood work, scans, etc), as in actual diseases, so it's very subjective on the part of the person in the study, as well as the researcher, in determining the results. 

 

Going back to the topic of Johann Hari's book, Lost Connections, his research and analysis is so important because it leads us to discussing fixing the world around us instead of focusing on drugs which may or may not work and which, as we all know, can lead to real harm. 

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FarmGirlWorks
On 2/12/2018 at 4:21 AM, Shep said:

Shep, thanks for posting this... love DN! (more than Fox 🙂 ) and this was great. Ironically, I did a searched here for his name so I could post a thanks to you and found that I had posted about an interview he did a while ago. Scrambled egg brain today!

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Shep
12 hours ago, FarmGirlWorks said:

Shep, thanks for posting this... love DN! (more than Fox 🙂 ) and this was great. Ironically, I did a searched here for his name so I could post a thanks to you and found that I had posted about an interview he did a while ago. Scrambled egg brain today!

 

DN is definitely a great source of news. I watch it every day myself. And the news of the harms of psych drugs is filtering through progressive media. The video I just posted on this thread yesterday is from Dr. Fraad, who is regularly seen on Dr. Richard Wolff's economics update show. She and Dr. Wolff regularly discuss our emotional woes within the context of our growing economic crisis. Just a brief 3 minute clip:

 

Economic Update: The System's Unwanted Results [CLIP] video (3 minutes)

 

The New York Times article, two Psychiatric Times articles, and Hari's book - all in a span of only three or four months - have influenced progressive media greatly. (BTW, if you're interested in the full interview with Dr. Wolff and Dr. Fraad, it's the last 30 minutes of this podcast - Economic Update: The System's Unwanted Results podcast).

 

Dr. Wolff periodically appears on DN, and so the information circulates and accumulates. Eventually, word will get out. 

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FarmGirlWorks

@Shep: I watched the Dr. Fraad interview yesterday; thanks for the other one 🙂 . The reality slap was a little depressing as it is all too real. I listen to DN! almost every day; if I am in a dark place, cannot do it as it breaks my heart what is really going on. However! Last month, under super WD duress, I submitted a piece to REI for a "'zine" they are doing called "Force of Nature" that celebrates women environmentalists. I did a piece where I put photos of current, American female warriors for the land (eg Terry Tempest Williams, May Boeve, the woman from Flint who discovered the dirty water, etc) and included Amy Goodman as she is one of my heroes for the work she does. It was selected so in the future (anehedonia these days) will feel glad about that, I hope. It is great that the dangers/reality of pyschotropic drugs is getting more coverage.

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brassmonkey

Congratulations on getting published, well done.  I've been a big fan of REI for many years.  I used to get my mountain climbing equipment there way back when they were a members only cooperative.

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Shep
13 hours ago, FarmGirlWorks said:

However! Last month, under super WD duress, I submitted a piece to REI for a "'zine" they are doing called "Force of Nature" that celebrates women environmentalists. I did a piece where I put photos of current, American female warriors for the land (eg Terry Tempest Williams, May Boeve, the woman from Flint who discovered the dirty water, etc) and included Amy Goodman as she is one of my heroes for the work she does. It was selected so in the future (anehedonia these days) will feel glad about that, I hope. It is great that the dangers/reality of pyschotropic drugs is getting more coverage.

 

This is awesome, FGW! And "under super WD duress". You are yourself an American female warrior. B)

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FarmGirlWorks

Ah, thanks, @Shep: I am having a rough morning, so needed that. Looking at your non-drug coping skills now...

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