Some weeks ago, in Antidepressants and Premature Death RxISK featured an article by Narinder Balsal and colleagues from Bristol in the British Journal of Psychiatry, which caused quite a fuss. See below.
Today we are posting about another article by her in PLoS Medicine. This comes with an Animated Trailer – the first RxISK post to feature one.
The article – Understanding ethnic inequalities in mental healthcare in the UK: A meta-ethnography – is the first meta-ethnography RxISK has featured.
It takes several days to read it fully and even longer to digest it. The Animated version comes in very handy as a guide to what is going on. Several distinguished folk have commented that it is one of the most important articles ever, especially on the topic of race. Important because it gives all the research done on this issue and important because of the position it takes.
Race is where Harry and Meghan come in – link included in case you’ve never heard of them. When they ran into difficulties, Harry apparently faced his father and brother telling him that all the women who came into the family had difficulties, so just suck it up.
To which Harry replied that this was different because of the Race Factor. Was it? Is it? Entering any new family can be difficult and there can be a temptation to re-read these difficulties in terms of race, or something else, rather than confront a difficulty common to all of us across cultures.
Race impacts on both health and mental health. The vaccine posts are full of Race. The Ventavia operation, that Brook Jackson reported on, along with other trial centres competed to be involved in the Pfizer vaccine trial on the basis of an ability to recruit people from diverse backgrounds – non-whites.
Buenos Aires was a godsend to any trial attempting to meet diversity quotas – offering as it did so many Latinos and non-whites.
There is nothing enlightened about this. It is a naked attempt to get more medicines into more people.
Some of the black heads of black universities and medical schools came under pressure to get their alumni to follow their example and get vaccinated. There was a great response to this and government efforts in general from Tuskegee – you want us to Trust You, show us you are Trustworthy.
The Table below shows that Whites overwhelmingly are the takers of psychotropic drugs in America. The same is true for other drugs.
As Joseph Davis outlines in Chemically Imbalanced, Black, Asian and Hispanic communities are still more likely to try to support troubled teens or the rest of us from within their own communities rather than have them turn to pills.
As the debate usually goes, Black communities in particular are being deprived of healthcare and lacking health insurance they certainly are.
The other angle is they still stigmatize mental illness and new Black, Brown and Asian doctors are persuaded to help lift the stigma of mental illness in their communities and get folk taking meds.
This is the bad side to things but there is a good side.
It means Black, Hispanic and Asian communities are probably enjoying growing life expectancies compared to Whites whose life expectancies and replacement rates are falling. Those who figure there is a Great Replacement going on perhaps have something to learn from Black, Asian and Hispanic communities.
Having made this point, if you look more closely at the image above, you will see that while Black communities take less meds than White, there is greater use of antipsychotics than found among Whites.
This is particularly true when it comes to depot antipsychotics. Some of this will be linked to the use of drugs in foster care but it seems highly likely that, in many cases and overall, this is simply linked to being black and male. See Being Black.
Taking a depot antipsychotic in low dose voluntarily can be helpful but involuntarily and in even slightly higher doses, the experience is more likely to be torture – bad enough to lead to suicide. Antipsychotic drugs are among the drug most likely to cause suicide if not used with care – see Drugs Causing Suicide.
Black communities have had strikingly low suicide rates compared to Whites in the US – until recently. There is a growing rate of suicides among Black children and teenagers and young men that has been causing concern – Ring the Alarm – what is going on?
Nobody from another group, women, LGBTQ or whatever, is likely to have to experience anything quite like what happened the man in Being Black – at least not on a routine basis.
The solution offered in Being Black doesn’t work for Black folk either – perhaps because it was too individual. If 50 people – a community – organised to do something like this would it be different?
The image here is of Afghan women. It brings out a community dimension – but one that at least at the moment hasn’t worked. If you are up against power, its going to be a fight.
The image also brings out a hypocrisy. A Western Taliban are forcing people out of jobs, and splitting families with vaccine mandates and a resolute unwillingness to face up to the harms their drugs are causing, yet at the same time they sanctimoniously give out about abuses of power elsewhere. Lots of unvaccinated folk (men at least) would still be in jobs now if working in Afghanistan rather than North America.
Western women are being persecuted too – see Women and Antidepressants – for a litany of abuse and savagery. Or I Can’t Breathe II .
Young Black Men on Depot Antipsychotics are the ECT of our day – a visible symbol of a police power that we can see is wrong.
But White Women on Antidepressants is the greater reality at least in terms of an exercise of soft power that is leading to far more deaths and injuries and a comparable inability to get redress or be listened to.
Common to both is the ability of power to silence us – wherever there is Silence, there is oppression. This will not be solved by victims – it needs communities.
One of the best examples of a community forming in response to being silenced lies with the efforts of REACT19.org, Bri Dressen, Suzanna Newell with Team Humanity, and Jennifer Sharp (image below) with her movie Anecdotals.
The message of Shipwreck is that beyond race, sex, and gender, the people who are most comprehensively silenced are those who are injured by therapies. They are silenced even more than those who are victims of child abuse.
Narinder in response would likely point out that Race is the one place where there are laws and obligations that we can turn to in our efforts to make a difference. The problem here though is those with the deepest pockets can make the law work for them – unless we understand what we are up against and can handle Forked Tongues.
The opening paragraph mentioned controversay about Narinder’s earlier article about antidepressants
The pharmaceutical industry may even have intervened. The best reason to think they didn’t was because they rarely do – they get medical proxies to fight their wars for them.
An article appeared by Chittaranjan Andrade on all the flaws in Narinder’s study. It was published in an online section of the J of Clinical Psychiatry – a journal that publishes a lot of ghostwritten industry studies that lack access to the study data. We would post Dr Andrade’s article here except blazoned all over it is a message that it is illegal to post this copyrighted article and curiously it seems impossible even to copy chunks of text.
This appears to be a Link to the Andrade article. It talks about depression rather than antidepressants causing cardiac problems.
A blackly amusing example of this tactic was Lilly claiming Schizophrenia and not Zyprexa causes Diabetes. This was a wonderful test of whether most doctors, women and men, white and black, gay and straight, would go along with something so utterly farfetched. Lilly knew what they were doing and its what we are up against.
For a link to data on this issue – see Khan et al.
RxISK acknowledges that the experiences of those who have been harmed by medical treatments are the cornerstone on which it is built, and believes this should be the case for all of medicine.
See Black Robe, White Coat for more detail on this people acknowledgement
Three years ago, the Lieber Brain Institute at the Johns Hopkins University partnered with the African American Clergy Medical Association to establish the African-American Neuroscience Initiative in order to expand the number of African Americans participating in genome-wide association studies of so-called “mental illness,” with the stated ultimate goal of developing treatments based on an individual’s unique genetic makeup.
As I pointed out at the time, genetic determinist views of human behavior have not always served African-Americans well in the past. Why do some of them think things are going to be different this time around?
In a city where three hundred people — most of them young black males – die every year by gunfire, in which the mortality rate for black babies is twice that of white ones, schools are closing early because of lack of air conditioning, and too many citizens dwell in rodent-infested hellholes, is “personalized medicine” really the answer?
There’s an old saying: “Be careful what you wish for — you might get it.” If African-Americans demand their equal right to be overmedicated, they might find the results are other than what they were hoping for.
I see in that animation Keele University mentioned. The same establishment that removed a world expert on aluminium toxicity, shortly after this university receiving major funding (one of their funders is the Bill & Melinda Gates Foundation — coincidence I’m sure).  He had found in brain samples a big red flag concerning the use of aluminium used in many biological medicines. 
Well, I don’t know about a ‘Great Replacement’ going on as I can’t count fast enough but Dr Meryl Nass — who lost relatives in the Holocaust and an expert on bio warfare — posted a poem on her Substack page by Margaret Anna Alice.  Margaret in the poem brings up the word ‘democide’ which will surly change the ethnic ratios a bit. In addition to what is covered in her poem and considering Canada is one of the countries moving towards offering (?) euthanasia to the mentally ill, and the spanners being thrown into global food production, I’m sure both of them (including myself) would welcome firm evidence to the contrary. 
My own unqualified diagnosis of world situation is simpler than putting it all down to a great conspiracy (thats not to say though, there are no conspiracies). Consider this: Psychopathy in itself is not a mental illness and very few people with this trait are criminally inclined. Indeed, a world’s foremost expert on psychopathy found some holding high positions in management. , The problem arrises (excuse the over simplification) that after about ten generation of economic growth, enough individuals with this trait have watered down the corporate policies, government regulations, etc., which were in societies interest, to allow psychopaths to focus more, on doing what is in their own interests. To find solutions to this growing problem, it is import to keep separate the blame game from the functional short comings of democracy. For as the war time British Prime Minister Winston S Churchill said on 11 November 1947:
‘Many forms of Government have been tried, and will be tried in this world of sin and woe. No one pretends that democracy is perfect or all-wise. Indeed it has been said that democracy is the worst form of Government except for all those other forms that have been tried from time to time.…’
Over simplified admittedly but the end of these current world events, as always, comes when enough people become aware of the reality, then act accordingly and with the courage that comes from knowing full well what the future holds for them and family if they don’t. The original meaning of apocalypse is “uncover, disclose, reveal”. Thus an apocalypse heralds a new start. Perhaps future democracies will be updated to include more safeguards without diminishing freedoms.
[Oh. I’m sounding like that mythical goddess Cassandra mentioned in the comments of the previous article. From descriptions of her, it suggests to me, she suffered from psychosis featuring precognition and thus cursed with no one believing her (due to her being considered mad – she looks it too in the painting, as she is pulling at her hair). In psychosis the hyper active brain can often guesstimate how a situation is going to work out, only then to be accused by those that couldn’t, of being an accomplice, which only adds injury from having no one believing their earlier suspicions.]
The significantly important difference I find between today and the ancient Egyptian, Persian, Greek civilizations was when they became too exhausted by war to fight no more, they didn’t have as a last resort, the option to use thermonuclear weapons — we do.
 University Shuts Down World-Renowned Aluminum Expert’s Research After Big Pharma Sets Up Shop on Campus
 Guillemette Crépeaux, François-Jérôme Authier, Christopher Exley, Lluís Luján, Romain K. Gherardi. The role of aluminum adjuvants in vaccines raises issues that deserve independent, rigorous and honest science. Journal of Trace Elements in Medicine and Biology, 2020, https://hal.archives-ouvertes.fr/hal-03492551/document
 Poem by Margaret Anna Alice.
 Corporate Psychopathy: Talking the Walk Paul Babiak, Ph.D.y, **, Craig S. Neumann, Ph.D.z and Robert D. Hare, Ph.D.*
 The 10 professions with the most psychopaths
I agree. Think the true cause will be found to be epigenetic rather than genic. Probably due mainly to a radical change in diet. Can’t find any convincing mechanistic explanation for this yet so this is more of a gut feeling.
“In 1932, Ødegärd found that Norwegians emigrating to the US were twice as likely to be admitted to hospital with first-onset schizophrenia as native-born Americans or Norwegians residing in Norway. Subsequent studies have confirmed the high incidence in migrants, demonstrating an overall relative risk of 2.7 in first-generation migrants and 4.5 in second-generation migrants”
Both Norwegians and Afro Caribbeans strike me as having very different ancestral diets compared to the foods commonly consumed in their new adopted counties. This may be a larger environmental factor that cultural.
Schizophrenia in black Caribbeans living in the UK: an exploration of underlying causes of the high incidence rate
P.S. D.H. You can copy chunks of Chittaranjan Andrade article from the web page itself AND the pdf version AFTER it is downloaded and opened. What you’re seeing before downloading is not an HTML page.
One wrote on Xavier’s Facebook page, “Our children are not lab rats for drug companies. I cannot believe that Xavier is participating in this. This is very disturbing given the history of drug trials in the black and brown communities.”3
How Has History Shaped the Black Community’s View of Vaccines?
“There’s a difference between being hesitant and being an anti-vaxxer.”
Fueled by a History of Mistreatment, Black Americans Distrust the New COVID-19 Vaccines
“You need to create ambassadors, then that vaccine hesitancy that communities of colour are concerned about will begin to mitigate or disappear”
Till is a profoundly emotional and cinematic film about the true story of Mamie Till Mobley’s relentless pursuit of justice for her 14 year old son, Emmett Till, who, in 1955, was brutally lynched while visiting his cousins in Mississippi. In Mamie’s poignant journey of grief turned to action, we see the universal power of a mother’s ability to change the world.
‘Hollywood wasn’t interested’: Barbara Broccoli on Till and confronting US racism
“I believe that this film will make a big difference to people who see it … Anything that promotes empathy or a deeper understanding is vitally important and cinema has the power to open people’s minds.”
This new release won’t ‘spare’…
Throughout the pandemic we have been inundated with pious platitudes about the disproportionate impact of COVID-19 on communities of color. What a pristine example of flipping the script, in order to draw attention away from the authorities’ murderous denial of safe and effective remedies for a disease that kills African-Americans at one and a half times the rate it kills the general population.
I have to admit a grudging admiration for that level of chutzpah.
Over here in Latin America we are doing our best to encourage high quality clinical trials in an ethnically diverse community.
We need more drug companies to consider, for instance the Dominican Republic
And who would have thought that Colombia would become famous for drug trials?
Drug trials typically are 30% cheaper here.
https://www.latinosinclinicalresearch.com/ are supporting this revolution.
Now the Johns Hopkins Brancati Center for the Advancement of Community Care is inviting folks to celebrate Martin Luther King’s birthday by getting their covid boosters. As I said, you gotta admire their chutzpah.
I don’t want to take anything away from these comments. When the Pope and Archbishop of Canterbury agree that Jesus would have had the vaccine, who are we to protest.
It is no surprise that the powerful Tuskegee article has influenced how this post has been read but the post is about mental illness and race and all comments to date are by white men – except one by Annie.
I want the white men to continue commenting but there is a notable irony here. What’s going on?
Well spotted, dude! First of all, it’s sad but true: This blog has very few regular Black readers. Maybe because we focus a lot on the harm done by psych drugs, especially anti-depressants. And there are a lot less Black folks getting access to those drugs. (There are times when having the healthcare system slam the door in your face can be a bit of a blessing in disguise. Doctors’ tendency to dismiss the pain complaints of black patients, or suspect them of being dope addicts or dealers, turned the opioid pill epidemic into a profoundly white plague for many years.)
As for Covid and Covid vaccines, the script has flipped in important ways since 2020 — mostly political ones. Back in 2020, Operation Warp Speed was a Trump project. If people like those Black Xavier U. parents had doubts about the vaccines, they did not feel the least bit shy about expressing themselves–back in 2020. But things have changed.
Now the vaccines (along with Covid-control policies) are seen as a “progressive” cause. Young folks, people of color, the liberal or the radical feel duty bound to defend them. You almost wonder if having doubts means you are turning into a racist, a fascist or both (and some Twitter scold will accuse you of it soon enough). Many conservative or right-leaning folks, meanwhile, are ashamed to be seen wearing a mask, much less getting a shot, for similar reasons. Men especially: What are you, some kind of pussy? the Twitter trolls will sneer.
Last but not least, those who aren’t Black may feel like the wisest thing is to step back and let those who know the situation first hand speak first. It’s basically a good impulse, but you can take it to extremes. And women tend to step back and give the floor to others far more readily than men. (Probably more a matter of our training than our Low T.)
This is pretty crazy of course. There is nothing left-wing or right-wing about a blood clot, a T cell, a pill or a virus. But the pressures are powerful. Especially in the Land of the Free.
OK, sisters and brothers! Free speech time. Discuss!
Taking the Tuskegee opinion piece as an example, does not the view (and assumptions) change according to whether one is standing in field, forest or on hill top. The authors use a lot of a priori judgments and combine them with empirical population data (ignore that the November 2020 data included gun shot, drowning, automobile accident victims etc., being recorded as Covid deaths which would slew the black/white ratios a tiny bit).
By the end of last year, very poorly vaccinated Uganda became free of Covid and African countries just don’t appear on the world Covid map anymore. They have achieved natural heard immunity from infections of Omiron. Would it not be fair for an African doctor looking at where the red circles do appear on this map and the regions of high excess mortality, to say to himself “Those White folks are way too Trusting.” Then in his wont to spread enlightenment, pens a letter to The New England Journal of Medicine, thinking that by this means his words will reach many wise and thoughtful White doctors.
Empirical Evidence before Theory — Covid-19 Vaccine Trials and the White Community.
As the race to develop a vaccine for Covid-19 has reached phase 3 clinical trials, concerns are increasing about the high rates of trial participation in important groups, and mainly the White communities. It is a parents first responsibility to ensure that they can care for their families in the way that non white groups do. They must be helped to understand that in the real world they can not rely on the good will of others nor the generosity of the government to take on the burden of looking after their dependants if the clinical trial – in which they choose to participate – does not go well…
It seems to be a truism that those already with limited resources and amenities have a better reality based understanding (they can’t afford to be otherwise), where they don’t welcome the focus to be on medical interventions to mitigate just one facet of living in an unhealthy environment as much as they value assistance in dealing with the causes, which will have longer lasting benefits. Their priorities like everyone else, differ according to real self evident situations, personal needs and adapt their behaviour accordingly.
What is there of tangible substance which is real world related (in their real world ‘social’ reality) in most of the high profile prattling, pseudo debates and opinion pieces. Why would non white, non middle class people in 1 st world nations feel inclined to join in when their gut feelings tell them that all the Opinion Leaders are interested in hearing from them is affirmation of agreement of whatever fad-of-the-month is being spouted from the pulpits?
Comic bewails “an advert for my demographic” …
An Antidepressant Ad for Black People –
Biniam Bizuneh – Stand-Up Featuring
“For Black People written by White People” …
Comment from Narinder
Interesting to see the comments. I think the lack of comments from people from ethnic minority backgrounds, and lack of engagement with these kind of platforms in general, is largely due to battle fatigue. The communities who are the most severely affected by these inequities and inequalities are also the most marginalised, oppressed, trying to survive – first the oppression, and then the mental health system. All my engagement with these communities has been via outreach and relationship building over months/years. The reason I created the animation – most people don’t have the time or capacity to read or digest the paper telling their story. And triggering for many – who have no support to help them when they are being triggered. Someone once told me that they were advised to suppress local statistics showing ethnic inequalities because they would ‘just make black folk more angry’.
But reports of medication side effects are there and one of the main reasons people were saying it is “useless” or “not worth taking the risk”. There are a lot of stories in the community grapevines, everyone knows someone who knows someone who was doing okay until they got sectioned and drugged up. See in our paper where this is referred to as “zombies”. I think under the metaphor “victim of the system” or “battling against”. The main inequity in terms of treatment is that people from ethnic minority groups are less likely to receive talking therapy and more likely to be offered medication as the only treatment option, often forced during detention, and more likely to experience chemical and physical restraint and seclusion during hospitalisation. Also less likely to be discharged on time.
Some other work I have been involved in – the psychiatric team spoke about how they are more likely to give a premature discharge to ‘white middle class’ patients who speak and dress well despite the presence of ‘disturbing’ behaviour and that in contrast even a well-spoken black man without any pathology will have trouble gaining discharge. The racial/class/gender (pick your intersection) stereotypes effect everyone negatively – facilitated by a process of assessment that prioritises appearance/patient presentation. In our paper, there were a lot of examples from patients and clinicians of ‘normal’/everyday experiences being pathologised as illness if it was coming from the mouth of a person who was the ‘ethnic’ other.
Thank you for your comments, new paper, and expertise.
This organization is Treating Depression in Africa at Scale StrongMinds will reach 2 million African women by 2025 without the use of medication.
This doesn’t help all those you have outlined, but it would be a complete travesty for Africa to follow in the footsteps of the UK, in particular, who have no problem with antidepressants for the young, the old, and the in-between, who are suffering, becoming suicidal and sometimes homicidal, because of the constant denial by regulatory agencies who by deft of foot allow doctors to ignore the mounting cry of their patients.
At least Strong Minds are having a go at it in Africa.
Thanks Annie. I have been speaking with the local NGO’s in Zambia including StrongMinds who have an impressive record for treating depression in women. There are many other successful social interventions in Africa (Friendship Bench for instance). I think these are great examples of how the Global North can learn from the Global South. Particularly in terms of responding to the social causes of mental illness and providing non-stigmatising, empowering, and low-cost services for common mental disorders. However, the treatment of severe mental illness is a huge challenge and there are lots of parallels with the experience of people from ethnic minority communities in the UK in that government services are experienced as disempowering and stigmatising, avoided at all costs, and the main pathway to treatment is involuntary – either the relatives can no longer cope or someone in the community reports a disturbance and the individual is arrested and brought in to a psychiatric facility by the police.
When you say “terrified to take them” I have the strong impression that this is due to the smallest doses available are way too large for many people to cope with. If you recall the experiences of consultant psychiatrist Gwen Jones-Edwards who along with others took part in a Healthy Volunteer Study looking at the effects of Droperidol and Lorazepam.
Terrifying, is but one of the many descriptive words that can justly applied by some individuals. Some willingly suffer the effects in the belief it is for their benefit rather than make life easier for the nursing staff. Unless a psychiatrist is willing to try at least one such antipsychotic I can’t consider them qualified to prescribe them. On top of this numerous studies and two very large ones done 5 year apart showed low antipsychotic use produced better out comes.
Perhaps the aid poorer countries would benefit the most from is encouragement and knowhow to set up homes in the style of Dr. Loren Mosher’s community based service call Soteria.
“Soteria houses are often seen as gentler alternatives to a psychiatric hospital system perceived as authoritarian, hostile or violent and based on routine use of psychiatric (particularly antipsychotic) drugs.”
A psychiatric ward may look more chaotic with people pacing around, arms turning like windmills and shouting back to their voices without these drugs but what percentage are of danger to themselves or others? A short term cost cutting measure to reduce staffing at the expense of long term recovery?
So ‘who’ realty need these drugs? I offer it is the staff, the NHS Trust managers and pharmaceutical manufactures.
Loren Mosher M.D. talks about Soteria Project and non-drug treatments for Schizophrenia:. https://www.youtube.com/watch?v=qnryFXxl7yU
Whilst Canada now talks about euthanasia for those who are experiencing the downside of a dying empire treating people as economic units.
So back to the question of: What is the right balance? It surly can only be achieved from everyone rediscovering the natural fulcrum of our humanity. “Do unto others as you would have them do unto you” A principle that dates at least to the early Confucian times (551–479 BCE) and present also in Hinduism, Islam, Judaism, Taoism, etc. and suits all landscapes including Africa.
The University is located on traditional Blackfoot Confederacy territory. We honour the Blackfoot people and their traditional ways of knowing in caring for this land, as well as all Indigenous Peoples who have helped shape and continue to strengthen our University community.
Public Lecture: Dr. David Healy. Science Commons Atrium, University of Lethbridge. Thursday, January 26, 2023, 6:00pm-7:00pm. “Beware of doctors Bearing Gifts (Especially for Children)”
Many indigenous communities across Canada are concerned with substance use problems. These same communities are also concerned about the perpetuation of colonizing, generational trauma created by residential schools, stigmatizing approaches to mental health, and social narratives related to substance use problems. These problems are generational, often creating a cycle of addiction, mental health issues, stigma, and discrimination. Among many First Nations, Inuit, and Metis in Canada, there is a strong need for equity in substance use treatment. Successful treatment methods have proven to be based on and created for Indigenous culture. However, poor government policies, societal stereotypes, discrimination, and stigma continue to make it difficult to solve these issues.
Furthermore, these solutions need to consider the damage past policies and practices have created. Generational mistreatment has created deep-seeded issues that have become problems in and of themselves. This is especially true when it comes to mental health and substance use. Creating these solutions will not be an easy task but they are imperative to break the cycle and allow Indigenous populations to truly regain what they lost.
The struggles of a 17th century Jesuit priest as he goes on his mission to convert the people of Huronia into Christianity, to save their souls, as decreed by the French king.
‘We would post Dr Andrade’s article here except blazoned all over it is a message that it is illegal to post this copyrighted article and curiously it seems impossible even to copy chunks of text.’
The article is splattered with dire warnings that it cannot be copied but it is available as far as just reading it is concerned . Access isn’t prohibited by the Journal and it directs readers to download a PDF . -which gives the article in full. Don’t be tempted to reproduce it as would be illegal. I wonder if the reason the author has been so heavy handed about not allowing it to be reproduced has something to do with not wanting Narinder and colleagues’ article to be more widely read – or would that be too shabby a thought. It’s not the study specifically I am responding to but the right to read what is published is being denied.
A Primer on How to Critically Read an Observational Study on Adverse
Medical Outcomes Associated With Long-Term Antidepressant Drug Use
Chittaranjan Andrade, MD
J Clin Psychiatry 2022;83(6):22f14733
PDF Not allowed to copy the PDF but it can be read surely as there is no distribution involved just a reference to the work
Assessment Methods > Research Methods Statistics
This work may not be copied, distributed, displayed, published, reproduced, transmitted, modified, posted, sold, licensed, or used for commercial purposes. By downloading this file, you are agreeing to the publisher’s Terms & Conditions.
CLINICAL AND PRACTICAL PSYCHOPHARMACOLOGY
A Primer on How to Critically Read an Observational Study on Adverse Medical Outcomes Associated With Long-Term Antidepressant Drug Use
It comes after NHS Digital data from 2021 showed that 57% of people from mixed, Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 64% of people from a white family background.
The suggestion is that mental health services should be delivered in a way that is culturally appropriate and that language barriers are also removed.
Antidepressants exit must happen in stages, says medical watchdog
Reducing an antidepressant dose should be done in stages, with help from a medical professional, according to the National Institute for Health and Care Excellence (NICE).
It says this helps manage withdrawal symptoms that can occur from the drugs.
NICE has published new information that sets out how mental health care can be improved in England and Wales.
A committee of experts says community care services should work with patients to agree a treatment plan.
This includes assessing whether it is right for them to come off their medication and over what time period withdrawal should take place.
Another suggestion is that extra attention should be paid to adults from minority ethnic backgrounds who have depression.
It comes after NHS Digital data from 2021 showed that 57% of people from mixed, Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 64% of people from a white family background.
The suggestion is that mental health services should be delivered in a way that is culturally appropriate and that language barriers are also removed.
‘My anti-depressant withdrawal was worse than depression’
Doctors warn of antidepressant withdrawal
According to the NHS, antidepressant prescriptions reached an all-time high in 2022, with 8.3 million people taking them in England.
Statistics also show about one in six adults aged 16 or over in the UK experienced some form of depression in the summer of 2021, with the rate remaining higher than before the coronavirus pandemic and lockdowns.
‘No one-size fits all approach’
The recommendations are in addition to pre-existing ones on managing depression in adults, which were last updated in November 2021.
NICE suggested then that people with mild depression should be offered behavioural therapy or group exercise before medication is discussed.
Dr Paul Chrisp, who is in charge of NICE guidelines, said: “In many cases, people experience withdrawal symptoms, and the length of time it takes them to safely come off these drugs can vary, which is why our committee’s useful and useable statement for a staged withdrawal over time from these drugs is to be welcomed.
If you are affected by any of the issues in this article you can find details of organisations that can help via the BBC Action Line.
“But it should be stressed there is no one-size fits all approach to coming off antidepressants,” he added.
In response to the proposals, Prof Allan Young from the Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience said: “It makes complete sense that the guidelines for treating depression in adults – which were published in June last year- are followed.
“Whether it can be delivered given the current state of the NHS is another question.”
‘It was like a constant hangover times five’
John Junior, 34, started taking antidepressants in 2017 after being diagnosed with depression and generalised anxiety disorder.
Gradually building up his dosage of sertraline, he says the drug “really did help” curb suicidal thoughts he had been having.
However, he found the side effects unbearable.
“I suffered from palpitations, which is a horrible side effect, and I was getting all sorts of headaches, migraines, more severe anxiety and stuff, even high blood pressure as well,” he told the BBC.
“And then I’d be prescribed more medications to try and mask the other side effects I was experiencing.
“It got to the point where I thought I was going to be fully dependent on antidepressants,” he says.
During the coronavirus lockdown, he decided to come off the medication, but could not get through to his doctor.
“The phone was always engaged – which made it really difficult.
“I was experiencing more and more side effects and it just wasn’t working for me, my body reached its limit and I just knew I had to come off of them.”
He says going “cold turkey” caused “sickness, headaches, raw anxiety, sweats and sleepless nights” and likened it to a “constant hangover times five”.
John says he is coping well since coming off antidepressants and uses the gym and meditation to keep his mental health in check.
He welcomes the new NICE guidance and says: “I think having an individual plan would be a great idea because it would give people that structure. And having that communication and reassurance from medical professionals would be great.”
Stephen Buckley from the mental health charity Mind, says: “Medication helps some people, but it isn’t always right for others.
“If you’re taking medication for your mental health, you might reach a point where you want to stop taking it.
“We strongly suggest talking to your doctor or mental health team if you are thinking of withdrawing from your medication, you want to change medication, or you are experiencing withdrawal symptoms, so that you can be supported to come off or change your medication safely over time.”
Don’t go cold turkey: Doctors are urged to wean millions of patients off antidepressants gradually to ease withdrawal symptoms
GPs should wean patients off antidepressants, new guidelines suggest
Experts hope easing people over time will cut severity of withdrawal symptoms
Charities are worried doctors aren’t equipped to taper individuals’ medications
The changes come as record numbers of antidepressants are being dished out
GPs should wean patients off antidepressants to ease withdrawal symptoms and help reduce the millions reliant on the drugs, new guidelines suggest.
NHS watchdog Nice said adults who wanted to stop taking antidepressants should have doses reduced in stages, as opposed to going ‘cold turkey’.
Experts hope that easing people off the pills over time will cut the severity of withdrawal symptoms, helping more people to quit them successfully.
But charities are worried family doctors are not equipped to taper individuals’ medications and urged fewer prescriptions to begin with.
The changes come as NHS data shows record numbers of pills are being dished out, with prescriptions of antidepressants rising by 5.1 per cent in 2021/2022 – the sixth consecutive annual increase.
Official figures show some 21.4million antidepressant drugs items were prescribed between July and September 2022 alone.
Under the new draft guidelines, patients who wish to come off the drugs permanently should first agree with their doctor whether it is right to stop taking the medication, then the speed and duration of withdrawal from it.
Any withdrawal symptoms need to have been resolved, or to be tolerable, before making the next dose reduction, according to the panel of experts.
The quality standard, which sets out priority areas for quality improvement for the care of adults with depression, said more should be done to support ethnic minorities to access mental health services.
Just 11.9 per cent of people from mixed, Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 79.9 per cent of people from a white family background, it said.
Dr Paul Chrisp, of Nice, said millions of people were taking antidepressants and it was vital those who want to stop taking the medication should be helped by their GP or mental health team.
He said: ‘It should be stressed there is no one size fits all approach to coming off antidepressants.
‘The way it should be done has to be down to the individual and their healthcare professional, to agree a way which it can work and only when side-effects can be safely managed.’
The Daily Mail has long campaigned to raise awareness about overprescribing, warning that patients were often unwittingly being led into prescription medicine dependency.
Antidepressants, which include common brands such as Prozac, Cipramil and Seroxat, are proven to be an effective way of treating moderate to severe depression.
But research from charities has found many patients are left in the dark about the side effects of antidepressants and other psychiatric treatments.
In 2019, the watchdog changed its guidelines to acknowledge that for some, ‘severe’ side effects of coming off antidepressants can last ‘months or more’ with symptoms such as confusion, anxiety, sweating, sleep problems and ‘altered feelings’.
Mental health charity Mind welcomed the new guidelines, which it hopes will ‘provide a focus for improvement in this area’. But the charity said GPs would need help to deliver it, as there is no mandatory practice-based training in mental health, despite an estimated 40 per cent of all appointments involving the issue.
Stephen Buckley, Head of Information at Mind, said: ‘Unfortunately, we know that the vast majority of GPs don’t feel they really have the skills to help people taper their medicines.
‘As such GPs will need to receive proper support, resource and training to effectively help patients to do this.
‘It’s also important that patients are given enough information when they’re first prescribed medication, so that they understand the length of time for which they may be being prescribed them, or the potential difficulties they might face to stop taking them down the line.’
Professor Kamila Hawthorne, Chair of the Royal College of GPs, said antidepressants can be an effective treatment when prescribed appropriately, but most patients should not have to rely on medication long term.
She said: ‘More generally, what we do need to see improved is access to alternative mental health treatments in the community right across the country – and for staffing in general practice to be addressed, including increasing numbers of mental health therapists.’
Chrisp is interviewed on Today, R4, BBCNews,
somewhat less than Crisp, more marsh-mallow…
“Just 11.9 per cent of people from mixed, Black, Black British, Asian or Asian British family backgrounds completed a course of treatment for depression compared with 79.9 per cent of people from a white family background, it said.”
The Martian in me interprets that paragraph as:
Ergo, if 88.1% of Black, Black British, Asian or Asian British family background patients were able to recover before completing the current standard term of medication whereas only 20.1% of White people could. Then it follows that ‘priority areas for quality improvement is that more must be done to support White people in the mental heath services to bring them up to the higher recovery rates as exist in the coloured minorities.’
Martians also know from their many years of studying Earthlings that a cultural trait of White people is the belief that doctor knows best. and therefore the 20.1% would not have ceased treatment early unless they did indeed feel better.
Either way. All this is illogical Jim and not medicine as we know it.