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by Peter R. Breggin
Perseus Books, 2001
Review by Duncan Double on Dec 8th 2001

The Anti-Depressant Fact Book

This book focuses on the newer antidepressants, especially the selective serotonin reuptake inhibitors (SSRIs). As its title suggests, it contains many interesting facts. In particular there are insights about the role of pharmaceutical companies in controlling information about antidepressants. Breggin has obtained his awareness through his expert testimony in litigation against the drug companies.

The book also contains much speculation. Breggin is inconsistent in this respect as he is sceptical about biological claims for the effectiveness of antidepressants. He does not always seem to apply the same degree of rigour to scrutiny of assertions about the risks of these drugs.

Clearly the dangers of SSRIs is a topical issue. On June 6, 2001, too late to be included in Breggin's book, a unanimous jury in Wyoming, USA found that Paxil “can cause some individuals to commit suicide and/or homicide,” and that it caused Donald Schell to shoot his wife, daughter, and granddaughter, before turning the gun on himself. The jury awarded a total of $8 million in damages to the two families, although the award will be limited to the 80% of “fault” found against the pharmaceutical company GlaxoSmithKline.

Legal judgment is not necessarily the same as scientific fact. There is controversy about the causal role of antidepressants in producing manic switch, akithisia, suicide and violence. Breggin regards these relationships as facts. Furthermore, he regards discontinuations reactions, which are increasingly acknowledged to be problematic, as produced by the recovery of physiological functions following removal of the drug. However, psychological factors, which he does not consider, may also be important. The placebo effect in treatment can be powerful. Hence withdrawing a drug, which is thought to improve mood, may be expected potentially to cause discontinuation symptoms.

The overstatement in the book is a pity. It detracts from Breggin's more critical analysis. For example, it is very valid to point out that brain research has concentrated on the short-term effects of antidepressants. There has hardly been any study of the long‑term consequences and whether the brain recovers from the homeostatic effects of brain change as a reaction to the presence of antidepressant drugs.

The last chapter does not contain any facts or speculation about antidepressants. Instead it describes Breggin's principles of therapy of depression. He focuses on the importance of relationship and argues for drug‑free therapy. Certainly there needs to be more of an opportunity for drug-free care and treatment in mental health practice.

Breggin's position is principled. He has maintained his independence as a private therapist since 1968. Although there was overstatement in Toxic Psychiatry, his first book, his humane interest was apparent. It is still there, but it may be a little battle‑worn through conflict with pharmaceutical companies that will do virtually anything to protect their multi-billion dollar drugs. Breggin's bravery should be acknowledged. Whether he has got the facts about antidepressants correct remains to be confirmed. I fear he has not got them all right.

© 2001 Duncan Double

Duncan Double, Consultant Psychiatrist and Honorary Senior Lecturer, Norfolk Mental Health Care Trust and University of East Anglia, UK; Website Editor, Critical Psychiatry Network.