Response to Read, Kinderman, Moncrieff & Davies on antidepressants
(15th April 2019. Submitted as a response to their BMJ response with Stevie Lewis and James Moore . The BMJ did not publish)
I recall significant scepticism among UK psychiatrists, about the benefit/risk ratio of widespread antidepressant prescribing, several years before Charles Medawar openly questioned it in 1997, followed by David Healy and others.
John Read and his fellow responders position themselves as today’s leading critics of the psychiatric and general practice establishments, but in focusing narrowly on efficacy and withdrawal effects, they distract, perhaps unintentionally, from their own role in causing the current ‘epidemic of overprescribing’.
It is striking that a group containing two clinical psychologists makes no call for psychotherapy funding, but merely signals approval for ‘social prescribing’, an ambiguous concept which affords ample scope for simple advice to be variously repackaged in Department of Health press releases.
Three members of the group were authors of an influential 2013 paper which told us to ‘Drop the Language of Disorder’ (https://ebmh.bmj.com/content/16/1/2). Thankfully this exhortation seems itself to be increasingly dropped, but in the published works of the group it continues to cause distress and annoyance to many people with more severe and/or chronic mental disorders, and associated conditions such as ADHD.
It is widely believed that ‘Drop the Disorder’ exerts a depressing effect on funding for mental health and learning disability services, which over several decades has fallen from over 20% of the NHS, to a current low of 11%.
Four of the Read et al responders are members of the ‘Council for Evidence Based Psychiatry’ (CEP), which includes Dr Sami Timimi of the ‘Campaign to Abolish Psychiatric Diagnostic Systems such as ICD and DSM (CAPSID)’. The CEP has become the ‘secretariat’ for the All Party Parliamentary Group on Prescribed Drug Dependence (APPGPDD), and Read et al’s ‘It was pleasing to see NHS England challenge the ‘attitude of a pill for every ill’’ may be reminiscent of distinctly Conservative Self-Help discourse. It is appropriate, then, that the APPGPDD’s Chair (http://prescribeddrug.org/members/) is Oliver Letwin, a close adviser of Margaret Thatcher in the 1980s, and author of ‘Privatising the World’ (1988).
Perhaps Read et al genuinely believe they have been opposing the rise in antidepressant prescribing. But in undermining diagnosis by psychiatrists, and being silent about funding for support and psychotherapy, simple economics dictate that cheap generic SSRI antidepressants continue to be widely prescribed (very often as placebos) after brief and inadequate assessments by general practitioners.
(Anyone new to this blog may want to look at my related pieces, perhaps starting with The Myth of Critical Psychiatry & the links in that)