Obtaining the truth about psychiatric medication

Andrew A. Nierenberg in an editorial in Psychiatric Annals defends psychiatry against the Make America Healthy Again (MAHA) action plan to curb psychiatric overprescribing (see previous post). What he particularly objects to is Robert F. Kennedy, Jnr, resurrecting Robert Whitaker’s book Anatomy of an epidemic “to vilify psychiatry” and for saying that his cousin’s withdrawal from an SSRI antidepressant was worse that his own withdrawals from heroin. 

I commented on reviews of Robert’s books in a previous post. I’m not convinced Nierenberg takes Whitaker’s arguments seriously enough even if there may be some overstatement in his views (see eg. another previous post). 

I think what Kennedy is pointing to with opiate withdrawal is that such physical experiences tend to be short-lived over a few days, whereas antidepressant withdrawal can be prolonged and even occur some time after stopping. Personally I’ve always argued that this is because antidepressants create a belief system that they have been correcting a biological abnormality, which is difficult to resolve on discontinuation (see eg. previous post).

As Nierenberg also points out, Kennedy has implicated SSRIs in mass shootings. I have always been sceptical that SSRIs can cause violence through a physiological mechanism, such as akathisia (see eg. previous post). Psychiatry itself at times has seemed to take on the projection of blame for not preventing mass shootings (see eg. another previous post). Why people run amok in American society does need to be taken seriously (see yet another previous post).

With such a polarised debate about psychiatric medication, it’s not easy for patients to negotiate the truth. I’ve complained multiple times in this blog about psychiatry marginalising critique by calling it anti-psychiatry as does Nierenberg (see eg. previous post). I agree with him that we do need to create a clearer position for patients.