What does it mean to say that antidepressants are not addictive?

The Royal College of Psychiatrists has published a leaflet with the results of a survey about coming off antidepressants, which I mentioned in a previous post. Generally, I think this is a helpful leaflet. However, it ends with a throw-away remark, "We would like to reassure readers that despite some people having symptoms of withdrawal when stopping antidepressants, antidepressants are not addictive".

I think what is meant is that there is no evidence that the body gets addicted with antidepressants. However, people can get psychologically addicted and it seems confusing to restrict the use of the term 'addiction' to physical addiction. GlaxoSmithKline, the makers of paroxetine, eventually dropped its insistence that paroxetine is not addictive, I think at least partly because of this confusion (see Guardian article).

Helpfully, the survey confirms that the primary symptom of antidepressant discontinuation is anxiety. This would fit with my argument that antidepressant discontinuation problems are due to psychological dependence (see my Antidepressant discontinuation reactions webpage and my book chapter Why were doctors so slow to recognise antidepressant discontinuation problems?)

Restricting the critique of psychiatry

One of Thomas Szasz's last papers (see previous post) was the write-up of an invited address, presented at the Annual Meeting of the International Society for Ethical Psychology and Psychiatry (ISEPP), Los Angeles, California, 28 October 2011. Szasz wanted to monopolise psychiatric criticism, restricting it merely to the abolition of psychiatric coercion. In my view, to do so undermines the critique of psychiatry.

The primary problem with modern psychiatry is its reduction of mental illness to bodily dysfunction. Objectification of those identified as mentally ill, by insisting on the somatic nature of their illness, may apparently simplify matters and help protect those trying to provide care from the pain experienced by those needing support. But psychiatric assessment too often fails to appreciate personal and social precursors of mental illness by avoiding or not taking account of such psychosocial considerations (see previous post). Mainstream psychiatry acts on the somatic hypothesis of mental illness to the detriment of understanding people's problems.

Szasz was correct that he first made this argument in The myth of mental illness but its impact was undermined by his insistence on the abolition of the Mental Health Act. 

Inaugural meeting of London Asylum Group

Dave Harper has called the inaugural meeting of the London Asylum Group at:

6.30-7.30pm
Thursday 18 October
Studio 2 (first floor), Oxford House, Derbyshire Street, Bethnal Green, London E2 6HG.

Oxford House is 5-10 mins walk from Bethnal Green tube.

Following the lead of other local groups like the one in Manchester, the aim of the group is to support the work of the Asylum: The magazine for democratic psychiatry.

Asylum needs volunteers to help raise the magazine's profile: to increase subscriptions (so that it can continue to grow) and to let people know it is a place for them to send and read interesting articles, poems and artwork.

The main item on the agenda will be staffing a stall Dave is booking at the London Anarchist Bookfair which runs from 10am-7pm on Saturday 27 October and is held at Queen Mary, University of London, Mile End Road, London, E1 4NS. If you can’t attend the meeting on 18 October but would like to help staff the stall on 27 October do get in touch with Dave.

The bookfair is the kind of place where we might interest new subscribers. At the meeting on 18/10 we can also spend some time thinking about other events where we might sell the magazine.

I know you're all really busy but hopefully it will be both fun and productive. Drop Dave a line if you're interested.

Dave organised the Critical Mental Health Forum that met in London over several years.

No use for brain scan in assessing psychiatric patients

Stephen Stahl, who I've mentioned in a previous post, in an editorial in Acta Psychiatrica Scandinavica, talks about psychiatrists becoming 'disease scene investigators'. He anticipates psychiatrists being able to combine what he calls the art of good clinical judgement with the scientific results from a structural brain scan, functional brain images from psychiatric stress tests and genetic information to decide on appropriate medication.

He admits that, "We are still, however, a long way from getting brain scans of patients to diagnose their schizophrenia or to monitor their course illness over time." He goes on, "In fact, it is beginning to look like no structural, functional or genetic test will ever diagnose schizophrenia or tell us what drug to use or avoid. It is not likely to be that simple."

He further tempers his wishful thinking with a cautionary comment that "at the forefront, things can get a bit turbulent and slip too far ahead of long-term evidence-based practice standards". Why not just stick to psychiatric formulation (see previous post)?

Defender of individual responsibility and freedom dies

Death notice for Thomas Szasz who died at the weekend. He contributed to critical psychiatry in the sense that he regarded the biological basis for mental illness as a myth.

He expressed himself forthrightly and clearly. As far as he was concerned, society shouldn't incarcerate people on the basis of so-called mental illness. I have been critical of the way his trenchant position could be said to have actually detracted from the cultural critique of medicine and psychiatry (eg. see my review of Pharmacracy). As he said to me in an e-mail a couple of years ago, "you and I draw the line at very different places: you at conceptual issues, I at coercion-noncoercion (and psychiatric excuses vs no excuses)."

Nonetheless, we will miss his contribution to the debate about psychiatry (eg. see a positive perspective on his legacy from Phil and Poppy Barker). He was still active into his 90s and I attended a seminar he gave on the fiftieth anniversary of The myth of mental illness (see previous post). Despite his protests, he will always be associated with the history of anti-psychiatry (see my Historical perspectives on anti-psychiatry).