FACT: “Chemical imbalance” or "neurotransmitter deficiency theory" was deployed by pharmaceutical companies to advertise their #psychiatric psychotropics. Never been scientifically proven, debunked many years ago, still circulating as rumor 20+ years later.
See sources below. /1 Source #1:
cepuk.org/unrecogni.../m…
Source #2:
psychiatrictimes.com/.../debunking-…...
Source #3:
researchgate.net/.../315533279_…...
Source #4:
healthline.com/.../chemical-i…...
Source #5:
psychologytoday.com/.../dont-say-d…...
Source #6:
madinamerica.com/.../chemical-i…
Source #7:
joannamoncrieff.com/.../the-chemic… /2

@_pem_pem Why this is nonsensical: "Jeffrey Lieberman, a professor of #psychiatry at Columbia University...“The problems that they’ve been criticized for have more to do [with] the way they’re used by doctors & the heterogeneity of the condition that they’re indicated for.” /1 @_pem_pem What Lieberman is saying is that if #antidepressants were prescribed to a population for which they are known to work well, they would have a much better track record. This is true, because it is a tautology. /2

Monoamine hypothesis aka "chemical imbalance" & other synonyms, arose circa 1965, but was known to only #psychiatrists, who were unhappily prescribing TCAs and MAOIs to a niche market. Patients hated the many adverse effects of the drugs. /1 Until mid-1990s, monoamine hypothesis (aka "chemical imbalance", "serotonin deficiency" etc.) was not circulating as a "folk model", not in medicine or in the general public. 1990 is ~center of this chart, when #psychiatrists, many paid by pharma, started churning out papers. /2

Lewis, et al. respond to letters to the NEJM editor, demonstrating they do not understand basic concepts of #antidepressant withdrawal @ANTLERtrial

Maintenance or Discontinuation of Antidepressants in Primary Care | NEJM nejm.org/doi/full/10.10… @ANTLERtrial Some in non-discontinuation group were taking their drugs inconsistently. Lewis, et al. missed potential withdrawal symptoms in that group: "but participants reported some new & worsening symptoms while continuing to take #antidepressants"

@sanilrege @markhoro @SenadHasanagic1 Not at all, Sanil. Among my site members, many people come off #antidepressants & other drugs with slight or no withdrawal symptoms except an emotional anesthesia, which they may describe as depression, anhedonia, various kinds of malaise, even "relapse" but.... /1 @sanilrege @markhoro @SenadHasanagic1 ....it's a "relapse" unlike anything they've experienced before. While they may use #psychiatry's vocabulary, because that's all they've got, this emotional anesthesia is actually a result of long-term psychotropic exposure, not "relapse"..../2

With all due respect to the fine @awaisaftab, these are the varieties of #antidepressant withdrawal syndrome:

1) WS with only physical, no emotional symptoms
2) WS with both physical & emotional symptoms
3) WS with only emotional symptoms
4) WS manifested as emotional anesthesia

https://twitter.com/awaisaftab/status/1443721094989484034

@awaisaftab Of the above, types 1 & 2 are WS, not "relapse", even if "depression" is present. Emotions such as those that compose "depression" do not exist apart from experience. Emotional reaction to feeling neurobiologically out of control should not be diagnosed as "depression".

$10K cost per patient: "In late 2012, when the team finally had 6 months of data on 90 patients, the depression-score reductions....[were] essentially matched by the control group, who after 6 months with inactive devices had 17% hitting the improvement target & 7% in remission."

https://twitter.com/shvogt/status/1445791909826338820

"As expected, it failed to help many....1st year, 10/90 patients left the study (& 4 had their devices removed), for reasons ranging from worsening depression to a suicide attempt. Eventually, of the 90 patients, 37—most of those who’d felt no benefit—had the devices removed."

"One of Freeman's youngest [lobotomy] patients is today a 56-year-old bus driver living in California. Over the past 2 years, Howard Dully has embarked on a quest to discover the story behind the procedure he received as a 12-year-old boy." npr.org/2005/11/16/501… "As those who watched the [lobotomy] procedure described it, a patient would be rendered unconscious by electroshock. Freeman would then take a sharp ice pick-like instrument, insert it above the patient's eyeball through the orbit of the eye...."

Dystonia from #psychiatric drugs since 2014: "I have worked so hard over the years to increase my physical activity after WD, so I am extremely proud of the 2 or 3 times a week that I manage to shuffle up & down the block, and manage to lift tiny weights." survivingantidepressants.org/topic/7485-wig… "If I "walk" (a.k.a. limp/amble/shuffle) too far or for too long, the D (dystonia) will flare. If I do too many reps with my small weights, the D will flare. If I have a cold or flu, the D will flare....I try maintain a balance of being lightly active so I can feel happy."

@sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk Sam, please note 3 Blind Psychs whining that there are real, serious flaws that need attention in #psychiatry but they are prevented from addressing them because dings from "anti-psychiatry" patients (on Twitter, no less) hurt their feelings. What does this say about the doctors? @sash_andy @samwoolfe @lisa63artist @jonathanstea @bmj_latest @hrw @C4Dispatches @gmcuk The epithet "anti-psychiatry" directed at patients is nothing but ad hominem from clinicians who have no intention of bringing patients into the discussions of improving clinical care. (This is #psychiatry we're talking about, the science of human emotion.)

@awaisaftab Hello, Awais. I will attempt to answer your excellent questions. @HengartnerMP may wish to add his perspective as well. /1 @awaisaftab @HengartnerMP Re your #2: This was a retrospective study. Duration & symptom criteria from Chouinard & Chouinard, 2015 were used in selecting subject population. Other of C&C's criteria (C) were addressed in analysis & discussion. The paper only weakly corroborates C&C's criteria (C). /2

Let's unpack why @psychunseen publishes posts such as this one, seeking to delegitimize patient movements he's observed on Twitter. He's been doing this for more than a year. /1 First, everyone should be aware @psychunseen is a #psychiatrist who treats inpatients for the Veterans Administration in Los Angeles.

The target of the tweet is the "drop the disorder" people, but, ill-advisedly, he swipes at chronic Lyme & CFS patients as well. /2

@DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus My theory, published nowhere but Twitter, is that #antidepressants are psychotropics, & any psychotropic might be marginally effective for "depression" in some population, at very similar slim rates of efficacy.

Efficacy determined by subjective effect on subjective sensation. @DepressionLab @tkaiser_science @Martin_Ploederl @HengartnerMP @CVolkmannMD @f_hieronymus Categorization of a drug as "antidepressant" is, of course, arbitrary. Some say benzodiazepines are antidepressants. Antipsychotics are promoted as antidepressant. Amphetamines & buprenorphine have been floated as antidepressant. Some like marijuana.

Any psychotropic will do.

@benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych There are a number of studies exploring both physician & patient attitudes towards going off #antidepressants.

Lack of physician confidence in tapering plays a large role. Their patients don't trust their knowledge, either, & rightly so. This is a subject nobody wants to unpack. @benzosarebad @wendyburn @_eleven13_ @BubblesTapering @rcpsych McCabe, J., Wilcock, M., Atkinson, K., Laugharne, R., & Shankar, R. (2020). General practitioners’ and psychiatrists’ attitudes towards antidepressant withdrawal. BJPsych Open, 6(4). doi.org/10.1192/bjo.20…

@DrFulli @lapsyrevoltee I do agree, Dr. Fulli. Response to the drug most certainly is not a diagnosis, & those physicians who conclude an adverse reaction to an #antidepressant is diagnostic of bipolar disorder not only have poor pharmacology knowledge but poor logical skills as well. /1 @DrFulli @lapsyrevoltee Even people with no pre-existing #psychiatric symptoms may have a severe adverse reaction to an #antidepressant or any other psychotropic.

Conversely, any psychotropic might relieve "depression" in someone, eg. amphetamines or opiates. This is another law of psychotropics. /2

"Professionalism in any field requires keeping pace with change, & nowhere is it more true than medicine....valid knowledge may come from the patient as well as from clinician resources: a sociological change driven by technological change." #psychiatry /1 journals.sagepub.com/doi/10.1177/00… "Case after case is presented showing that patients today have generated undeniable value, violating the expectations and assumed best practices of the old model." doi.org/10.1177/009121… /2

"As the meaning of the term has expanded, some #ePatients have developed a high level of expertise & in turn have taken a leadership role within the ePatient movement. @StanfordMedX has coined the term ePatient scholar to describe these leaders...." /1

ojin.nursingworld.org/mainmenucatego… Nelson, R., (September 13, 2016) "Informatics: Empowering ePatients to Drive Health Care Reform - Part I" OJIN: The Online Journal of Issues in Nursing Vol. 21, No. 3.

ojin.nursingworld.org/mainmenucatego… /2

UK woman tapering paroxetine: "After 18 years of stupor—of emotionless head fog, of sleeping 14 hours a day, of apathy—I’m succeeding in getting off the #antidepressant Seroxat." /1

linkedin.com/pulse/learning… After reducing to 7mg paroxetine: "I spent the first half of 2019 in continual, breathless, agitated terror.
....
I couldn’t sit still, and my constant squirming made my partner cry. I suspect I had something I’ve since found out is called #akathisia." linkedin.com/pulse/learning…

@psychunseen: "...if the goal of anti-psychiatry is to get #psychiatrists to listen...this is better done within a therapeutic relationship, not in a picket line at the American Psychiatric Association annual meeting or on social media" apparently refers to me personally. /1 I thought it stood out as particularly illogical in his most recent screed psychologytoday.com/us/blog/psych-…

Who pickets the APA other than Scientology?

"They considered their findings generalisable across healthcare....” bmj.com/content/370/bm… /1 "Perhaps most striking was the testimony from 100s of patients reporting lack of informed consent for...initial treatment, followed by years of dismissal by clinicians & regulators who did not want to associate life altering symptoms or injured children with their [products]" /2

@sandysteingard @awaisaftab Clarifying: Across psychotropics, withdrawal syndrome is not "time-bound" except by arbitrary distinction between acute & post-acute withdrawal syndrome #PAWS, which can last years & is often conflated with "relapse". Lerner & Klein, M. (2019). doi.org/10.1093/brainc… @sandysteingard @awaisaftab Presentation from a Merck scientist that lays out tolerance, withdrawal, protracted withdrawal #PAWS: Markgraf, C. G. (2012, October). Introduction to Physical Dependence and Withdrawal. 12th Annual Meeting. Safety Pharmacology Society, Phoenix, Arizona. safetypharmacology.org/AM2012/am12pre…