Pinned Tweet
1/ Thanks to @MikhailaFuller for allowing me to share my story. 🧵
My experience sits in the uncomfortable space between what patients are routinely told about antidepressants and what can, in many cases, actually unfold over time. It is not simply a story of adverse effects, it is a story about the consequences of incomplete information, overconfidence in simplified narratives and a medical culture that too often defaults to explanation rather than investigation when things go wrong.
I was prescribed the antidepressant Sertraline for situational panic attacks following a house fire when I was younger and remained on it for approximately 13 years. During that time, I was never meaningfully informed about the possibility of physiological dependence, nor about the potential difficulty of stopping the drug after long term use. The phrase “safe and effective” was presented as if it were a stable, universal truth, rather than a context dependent conclusion drawn from limited and biased data.
There was no discussion of what happens when the brain adapts to a drug over more than a decade. No acknowledgement that removing that drug might not be a neutral act. No mention of protracted withdrawal or that stopping could result in a severe and prolonged destabilisation of the nervous system. Informed consent, in any meaningful sense, was absent.
When I eventually came off the SSRI, it was done through a rapid doctor led taper that bore no relation to the duration of my use. What followed was not a return of my original symptoms, but the onset of something far more severe, complex, disabling and life changing.
Almost immediately, I began to experience intense and persistent surges of physiological anxiety and panic. These were not thoughts or worries in the conventional sense. They were full body events; overwhelming waves of adrenaline that arose without psychological trigger, accompanied by a profound sense of internal threat. They were not responsive to reasoning, reassurance or standard psychological strategies because they were not primarily psychological in origin.
Alongside this, I developed widespread neurological and sensory disturbances. I experienced constant “electric” sensations throughout my body, moving unpredictably through my arms, legs, hands and across my head and face. These were often painful, presenting as burning, tingling or sharp nerve like sensations. My muscles began to twitch involuntarily, with fasciculations and spasms becoming a daily occurrence. At times, my facial muscles would contract and twitch without warning.
One of the most severe and distressing symptoms I experienced was akathisia. It is often described clinically as restlessness, but that description is profoundly inadequate. What I experienced was an intense, unrelenting inner agitation combined with a powerful urge to escape my own body, alongside a compulsion to move that made stillness feel intolerable. At its worst, it generated intense suicidal urges, not from hopelessness, but from a desperate need to escape the sensation itself. It was not psychological distress in any conventional sense, it was a physical state that overrode any attempt at control. It is difficult to overstate how severe and destabilising this symptom has been for three years.
Sleep became almost impossible at times. I went through prolonged periods of insomnia, sometimes sleeping only three hours across several days. When I did manage to fall asleep, I was frequently jolted awake by hypnic jerks; sudden, violent awakenings accompanied by adrenaline surges. The cumulative effect of this sleep deprivation was profound, amplifying every other symptom and eroding my ability to cope.
Cognitively, I experienced significant impairment. I developed …
prescribed-harm.com/stories/story-…
My experience sits in the uncomfortable space between what patients are routinely told about antidepressants and what can, in many cases, actually unfold over time. It is not simply a story of adverse effects, it is a story about the consequences of incomplete information, overconfidence in simplified narratives and a medical culture that too often defaults to explanation rather than investigation when things go wrong.
I was prescribed the antidepressant Sertraline for situational panic attacks following a house fire when I was younger and remained on it for approximately 13 years. During that time, I was never meaningfully informed about the possibility of physiological dependence, nor about the potential difficulty of stopping the drug after long term use. The phrase “safe and effective” was presented as if it were a stable, universal truth, rather than a context dependent conclusion drawn from limited and biased data.
There was no discussion of what happens when the brain adapts to a drug over more than a decade. No acknowledgement that removing that drug might not be a neutral act. No mention of protracted withdrawal or that stopping could result in a severe and prolonged destabilisation of the nervous system. Informed consent, in any meaningful sense, was absent.
When I eventually came off the SSRI, it was done through a rapid doctor led taper that bore no relation to the duration of my use. What followed was not a return of my original symptoms, but the onset of something far more severe, complex, disabling and life changing.
Almost immediately, I began to experience intense and persistent surges of physiological anxiety and panic. These were not thoughts or worries in the conventional sense. They were full body events; overwhelming waves of adrenaline that arose without psychological trigger, accompanied by a profound sense of internal threat. They were not responsive to reasoning, reassurance or standard psychological strategies because they were not primarily psychological in origin.
Alongside this, I developed widespread neurological and sensory disturbances. I experienced constant “electric” sensations throughout my body, moving unpredictably through my arms, legs, hands and across my head and face. These were often painful, presenting as burning, tingling or sharp nerve like sensations. My muscles began to twitch involuntarily, with fasciculations and spasms becoming a daily occurrence. At times, my facial muscles would contract and twitch without warning.
One of the most severe and distressing symptoms I experienced was akathisia. It is often described clinically as restlessness, but that description is profoundly inadequate. What I experienced was an intense, unrelenting inner agitation combined with a powerful urge to escape my own body, alongside a compulsion to move that made stillness feel intolerable. At its worst, it generated intense suicidal urges, not from hopelessness, but from a desperate need to escape the sensation itself. It was not psychological distress in any conventional sense, it was a physical state that overrode any attempt at control. It is difficult to overstate how severe and destabilising this symptom has been for three years.
Sleep became almost impossible at times. I went through prolonged periods of insomnia, sometimes sleeping only three hours across several days. When I did manage to fall asleep, I was frequently jolted awake by hypnic jerks; sudden, violent awakenings accompanied by adrenaline surges. The cumulative effect of this sleep deprivation was profound, amplifying every other symptom and eroding my ability to cope.
Cognitively, I experienced significant impairment. I developed …
prescribed-harm.com/stories/story-…
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Sam Hall retweeted
Psychiatrists often say: "80% of psych meds are written by PCPs."
The data: PCPs wrote about half (51%) of psychotropic prescriptions in 2022, down from 64% in 2013. It may have been 80% at some point, or in other settings, this is Medicare Part D.
I am not a fan of blaming escribing. In my experience, PCPs (my grandfather was one) tend to follow guidelines and algorithms. In psychiatry, those are generally written by psychiatrists, or based on our work.
If PCPs are doing it wrong, or shouldn't prescribe psychotropics at all, we should say so much more clearly, and explain why.
Ref: Hooker et al., Medical Care 2026
The data: PCPs wrote about half (51%) of psychotropic prescriptions in 2022, down from 64% in 2013. It may have been 80% at some point, or in other settings, this is Medicare Part D.
I am not a fan of blaming escribing. In my experience, PCPs (my grandfather was one) tend to follow guidelines and algorithms. In psychiatry, those are generally written by psychiatrists, or based on our work.
If PCPs are doing it wrong, or shouldn't prescribe psychotropics at all, we should say so much more clearly, and explain why.
Ref: Hooker et al., Medical Care 2026
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Sam Hall retweeted
With thanks to @MITUKteam
And @Mad_In_America
A decade of the rise & rise of #FND
By Marion Brown @recover2renew
madintheuk.com/2026/11/a-deca…
And @Mad_In_America
A decade of the rise & rise of #FND
By Marion Brown @recover2renew
madintheuk.com/2026/11/a-deca…
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Sam Hall retweeted
Help ACE Bring Antidepressant Withdrawal Awareness to a National Audience!
ACE has been fundraising to produce a high-quality, nonpartisan, and professionally produced public service announcement (PSA) to raise awareness about the seriousness of severe antidepressant withdrawal—the kind that has upended the lives of so many in our community.
Thanks to the generosity of our supporters, we've raised $30,000 of our $70,000 goal!
Of the $70,000, $50,000 will fund production by a Los Angeles–based production company specializing in professional PSAs. The remaining $20,000 will go toward distribution, a critical component of ensuring this message reaches a broad audience, including the general public, patients, and prescribers.
Now, we're asking our community for help.
We recognize that many in our community are unable to work due to the debilitating effects of antidepressant withdrawal. If you're unable to contribute financially, we humbly ask that you share this post and help amplify our message. Sharing is a meaningful way to support this effort, and we're grateful for every person who helps spread the word.
If you're in a position to donate, please know that every contribution, regardless of size, is deeply appreciated. Your generosity will help bring much-needed attention to a topic that has too often been overlooked, misunderstood, or dismissed.
Together, we can raise awareness, reach those who need this information, and help change the way antidepressants are deprescribed.
The donation link is in the comments, where you can also learn more about the PSA and our plans for the campaign.
ACE has been fundraising to produce a high-quality, nonpartisan, and professionally produced public service announcement (PSA) to raise awareness about the seriousness of severe antidepressant withdrawal—the kind that has upended the lives of so many in our community.
Thanks to the generosity of our supporters, we've raised $30,000 of our $70,000 goal!
Of the $70,000, $50,000 will fund production by a Los Angeles–based production company specializing in professional PSAs. The remaining $20,000 will go toward distribution, a critical component of ensuring this message reaches a broad audience, including the general public, patients, and prescribers.
Now, we're asking our community for help.
We recognize that many in our community are unable to work due to the debilitating effects of antidepressant withdrawal. If you're unable to contribute financially, we humbly ask that you share this post and help amplify our message. Sharing is a meaningful way to support this effort, and we're grateful for every person who helps spread the word.
If you're in a position to donate, please know that every contribution, regardless of size, is deeply appreciated. Your generosity will help bring much-needed attention to a topic that has too often been overlooked, misunderstood, or dismissed.
Together, we can raise awareness, reach those who need this information, and help change the way antidepressants are deprescribed.
The donation link is in the comments, where you can also learn more about the PSA and our plans for the campaign.
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Sam Hall retweeted
Mums vs Big Pharma bbc.co.uk/programmes/m00…
GPs/specialists dismissed their concerns when their children began showing signs of developmental difficulties & disabilities, labelling them "bored, hysterical housewives".
An "insidious culture of defensiveness and blame". #Cumberlege
GPs/specialists dismissed their concerns when their children began showing signs of developmental difficulties & disabilities, labelling them "bored, hysterical housewives".
An "insidious culture of defensiveness and blame". #Cumberlege
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Sam Hall retweeted
I find it fascinating how so many people react to those harmed by prescription drugs by claiming ‘you knew the risks it was in the patient info slip’.
Often times, prescribers aren’t even aware of the risks and they have prescribed them to thousands of people.
If even prescribers aren’t aware how can you expect a patient to do what prescribers haven’t done?
Often times, prescribers aren’t even aware of the risks and they have prescribed them to thousands of people.
If even prescribers aren’t aware how can you expect a patient to do what prescribers haven’t done?
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Sam Hall retweeted
I have a clinician friend who attended the Deprescribing session by Stahl & Strawn in Colroado yesterday. I find it fasinating that they told attendees that there are “angry patients” online who are mad at psychiatry and that most of us are “borderline.”
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Sam Hall retweeted
"Kim Witzak writes on Substack about her recently launched petition calling for better research, stronger warnings, and truly informed consent regarding antidepressants."
buff.ly/aQHp6pw
buff.ly/aQHp6pw
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Sam Hall retweeted
"Are You Adequately Informed?:
A Survey of Patient Recall and Preferences Concerning SSRI Side Effect Information"
Nicolas Badre, MD
David Cohen, Ph.D.
Eric Geier, MD
A research report from Inner Compass Research Institute
July 2026
LINK TO READ FULL REPORT: buff.ly/XLCQm7K
"About This Report
This report presents findings from a national online survey of 1,260 U.S. adults with a history of SSRI prescription. The study examines what side effect information respondents recalled receiving from prescribers, what information they would have preferred to receive, and the size of the gap between recalled education and patient preference.
The report focuses on informed consent as an ethical and practical issue in SSRI prescribing. It does not evaluate individual prescribing decisions, determine whether any specific provider met or failed to meet legal standards, or offer individualized medical advice. Instead, it contributes empirical data
to a broader question: whether current prescribing conversations provide patients with the information they consider meaningful before starting SSRI prescriptions.
This report has been peer-reviewed according to the organization’s tiered peer-review system."
LINK TO READ FULL REPORT: buff.ly/XLCQm7K
A Survey of Patient Recall and Preferences Concerning SSRI Side Effect Information"
Nicolas Badre, MD
David Cohen, Ph.D.
Eric Geier, MD
A research report from Inner Compass Research Institute
July 2026
LINK TO READ FULL REPORT: buff.ly/XLCQm7K
"About This Report
This report presents findings from a national online survey of 1,260 U.S. adults with a history of SSRI prescription. The study examines what side effect information respondents recalled receiving from prescribers, what information they would have preferred to receive, and the size of the gap between recalled education and patient preference.
The report focuses on informed consent as an ethical and practical issue in SSRI prescribing. It does not evaluate individual prescribing decisions, determine whether any specific provider met or failed to meet legal standards, or offer individualized medical advice. Instead, it contributes empirical data
to a broader question: whether current prescribing conversations provide patients with the information they consider meaningful before starting SSRI prescriptions.
This report has been peer-reviewed according to the organization’s tiered peer-review system."
LINK TO READ FULL REPORT: buff.ly/XLCQm7K
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Sam Hall retweeted
Useful response by @markhoro to the tedious recitation of long-debunked myths about antidepressant efficacy in Jack Goulder’s recent guest post on @awaisaftab's blog.
Progress towards a reality-based discussion of antidepressant efficacy and safety continually runs aground on of mental health professionals. Every biologically inclined psychiatrist has a story about a patient who made a miraculous recovery after taking antidepressants. The anecdote is reliably given more weight than the systematic evidence showing that the ratio of risks to benefits is overwhelmingly negative for the vast majority of people they are prescribed to. And so we make mental health policy based on ‘vibes’ rather than facts.
Commentators like Goulder get round this by simply not engaging with critical interpretations of the evidence they cite. Unable to address the arguments of his critics in evidence-based terms, he casts aspersions on the motives of people like Mark and @joannamoncrieff instead. His piece is full of weirdly politicised psychoanalysis, intended to discredit people who have done crucial work to improve informed consent and patient safety. Incredibly frustrating. Mark and Joanna’s work is one of the few places in the discourse where the experiences of people harmed by antidepressants are actually represented. 👇
Progress towards a reality-based discussion of antidepressant efficacy and safety continually runs aground on of mental health professionals. Every biologically inclined psychiatrist has a story about a patient who made a miraculous recovery after taking antidepressants. The anecdote is reliably given more weight than the systematic evidence showing that the ratio of risks to benefits is overwhelmingly negative for the vast majority of people they are prescribed to. And so we make mental health policy based on ‘vibes’ rather than facts.
Commentators like Goulder get round this by simply not engaging with critical interpretations of the evidence they cite. Unable to address the arguments of his critics in evidence-based terms, he casts aspersions on the motives of people like Mark and @joannamoncrieff instead. His piece is full of weirdly politicised psychoanalysis, intended to discredit people who have done crucial work to improve informed consent and patient safety. Incredibly frustrating. Mark and Joanna’s work is one of the few places in the discourse where the experiences of people harmed by antidepressants are actually represented. 👇
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Sam Hall retweeted
I've responded briefly to Jack's blog here: mhorowitz.substack.com/p/unexamined-a…
The two major problems with Jack Goulder’s blog (and the paper on which it is based) is, one, that Jack is working from the unquestioning (and largely unexamined) assumption that antidepressants work and anyone who suggests otherwise must have mischievous motivation. And two, he has misrepresented what we have said about our umbrella review.
Jack said to me tellingly in an email:
“I should be clear that my academic background is in history and social science, not epidemiology or pharmacology. I’m not sure I’m qualified to give a detailed analysis of the subtleties of this quite vast literature!”
So without engaging with the debate about efficacy in any meaningful way he has embarked on what sounds like a year-long project on the premise that ‘the drugs work because senior people in my field agree they do’ and that he saw a young woman (with a different condition to the literature he is commenting on) improve with antidepressants ‘after a few months, and with the help of therapy too.’
This is not how science works. I sent him a very clear explanation of the issues with antidepressant efficacy written by a Cochrane group in Denmark – who I’m sure have never read Szasz! – published in the BMJ Open but he seems not to have read this: bmjopen.bmj.com/content/9/6/e0…
To just briefly re-state the issues with the Cipriani review on antidepressants (which provides the basis of Jack and other’s unshakeable belief in the efficacy of these drugs): presenting response rates inflates the small absolute differences between antidepressant and placebo.1 This difference is 2 points on a 52 point depression scale.2 This lies below any analysis of what constitutes a clinically important difference (rather than just a statistically significant difference).3,4 See figure above to illustrate some of these elements. These studies only examine effects at 8 weeks, whilst people take these drugs for years.5 Even the small effects at 8 weeks are likely to wear off due to tolerance – the corollary of any drug that causes withdrawal.6
There are also unblinding effects – people who know they are on the drugs have raised expectations which improve mood and these expectations inflate the apparent effects of antidepressants in placebo-controlled trials.7 For example, in an analysis of the TADS study treatment guess had a substantial effect on outcome, while actual treatment group (antidepressant or placebo) did not.7 The Stone et al meta-analysis did not refute the role of unblinding as Jack suggests, it merely notes that the trials it included did not test the integrity of the double blind design (Stone writes “We cannot fully exclude the possibility that the effects of the drugs are accounted for by functional unblinding”). 8
There is also massive publication bias.9 The studies which find 15% of people benefit at an 8 week time point suffer from all the same limitations as above.8 And if there is a small pharmacological effect in the short term from this class of medication it leaves the question of the utility – or the ethics – of giving people drugs that numb their emotions when they are distressed,10 especially with the risk that for a portion of them this numbing does not wear off when the drugs are stopped.11,12 Jack’s piece ignores almost all of these issues.
A central part of this argument is that Joanna and I put out a press release arguing that our paper had demonstrated antidepressants are ineffective. Notably he does not quote the lines from the press release in his blog or the paper – remarkable when this is a key part of his argument.
Of course the reason he does not quote this is because his assertion is false. We don’t anywhere say in our draft press release that we have demonstrated in our umbrella review of the role of serotonin in depression that we have demonstrated that antidepressants are not effective. The closest we come is when we say: “Therefore, this research calls into question reasons for the use of antidepressants.” The research does indeed undermine a common reason for the prescription of antidepressants.
I think what is most unsettling about this piece is that Jack has inverted the work of Naomi Oreskes. Her work and her book Merchants of Doubt sets out the playbook taken by large industries to undermine critics of their hegemony. When big tobacco was being criticised for causing lung cancer by researchers, it funded researchers who sewed doubt in this hypothesis by pointing to asbestos, stress, etc, anything other than tobacco which might cause lung cancer.
The same playbook was used by fossil fuel companies: as climate scientists started pointing the finger at this industry for driving climate change, scientists associated with industry put out arguments sewing doubt: temperatures natural vary, humans couldn’t be doing it, etc.
This is the identical playbook adopted by the pharmaceutical industry and its supporters when it comes to obscuring the harm of their products. Antidepressant withdrawal isn’t caused by stopping antidepressants, they say, it is caused by patient’s expectations of worsening (nocebo effects), their mental health condition returning, other diseases that co-incidentally occur at the same point (functional neurological disorder) and short-term withdrawal studies show that there is no real issue, etc.13,14
There is an absurdity to painting academics, many of whom are paid by one of the largest industries in the world as representing unimpeachably pure science and Joanna and a bunch of her academic colleagues (including me) as the ‘merchants of doubt’. Of course some of the scientists who defend the efficacy or minimise the harms of antidepressants are not paid by industry, but other interests, such as professional status, are also at play.
I would strongly encourage Jack and anyone reading his essay to go and read criticisms of antidepressant efficacy before jumping to conclusions that anyone putting forward a criticism of the current consensus must be mischieviously motivated.
The current (and poorly examined) consensus on the relative safety and effectiveness of antidepressants in the long-term has led to an avalanche of harm that can be seen spilling out onto social media, newspaper articles, government inquiries, parliamentary groups and, increasingly, concrete NHS projects and directives. Rather than expending further energy trying to shoot (and silence) some of the messengers it would be better for patients if psychiatrists examined the reality of what is occurring to patients and stopped deriving false reassurance from short term studies centrally concerned with commercial objectives.
References available at: mhorowitz.substack.com/p/unexamined-a…
The two major problems with Jack Goulder’s blog (and the paper on which it is based) is, one, that Jack is working from the unquestioning (and largely unexamined) assumption that antidepressants work and anyone who suggests otherwise must have mischievous motivation. And two, he has misrepresented what we have said about our umbrella review.
Jack said to me tellingly in an email:
“I should be clear that my academic background is in history and social science, not epidemiology or pharmacology. I’m not sure I’m qualified to give a detailed analysis of the subtleties of this quite vast literature!”
So without engaging with the debate about efficacy in any meaningful way he has embarked on what sounds like a year-long project on the premise that ‘the drugs work because senior people in my field agree they do’ and that he saw a young woman (with a different condition to the literature he is commenting on) improve with antidepressants ‘after a few months, and with the help of therapy too.’
This is not how science works. I sent him a very clear explanation of the issues with antidepressant efficacy written by a Cochrane group in Denmark – who I’m sure have never read Szasz! – published in the BMJ Open but he seems not to have read this: bmjopen.bmj.com/content/9/6/e0…
To just briefly re-state the issues with the Cipriani review on antidepressants (which provides the basis of Jack and other’s unshakeable belief in the efficacy of these drugs): presenting response rates inflates the small absolute differences between antidepressant and placebo.1 This difference is 2 points on a 52 point depression scale.2 This lies below any analysis of what constitutes a clinically important difference (rather than just a statistically significant difference).3,4 See figure above to illustrate some of these elements. These studies only examine effects at 8 weeks, whilst people take these drugs for years.5 Even the small effects at 8 weeks are likely to wear off due to tolerance – the corollary of any drug that causes withdrawal.6
There are also unblinding effects – people who know they are on the drugs have raised expectations which improve mood and these expectations inflate the apparent effects of antidepressants in placebo-controlled trials.7 For example, in an analysis of the TADS study treatment guess had a substantial effect on outcome, while actual treatment group (antidepressant or placebo) did not.7 The Stone et al meta-analysis did not refute the role of unblinding as Jack suggests, it merely notes that the trials it included did not test the integrity of the double blind design (Stone writes “We cannot fully exclude the possibility that the effects of the drugs are accounted for by functional unblinding”). 8
There is also massive publication bias.9 The studies which find 15% of people benefit at an 8 week time point suffer from all the same limitations as above.8 And if there is a small pharmacological effect in the short term from this class of medication it leaves the question of the utility – or the ethics – of giving people drugs that numb their emotions when they are distressed,10 especially with the risk that for a portion of them this numbing does not wear off when the drugs are stopped.11,12 Jack’s piece ignores almost all of these issues.
A central part of this argument is that Joanna and I put out a press release arguing that our paper had demonstrated antidepressants are ineffective. Notably he does not quote the lines from the press release in his blog or the paper – remarkable when this is a key part of his argument.
Of course the reason he does not quote this is because his assertion is false. We don’t anywhere say in our draft press release that we have demonstrated in our umbrella review of the role of serotonin in depression that we have demonstrated that antidepressants are not effective. The closest we come is when we say: “Therefore, this research calls into question reasons for the use of antidepressants.” The research does indeed undermine a common reason for the prescription of antidepressants.
I think what is most unsettling about this piece is that Jack has inverted the work of Naomi Oreskes. Her work and her book Merchants of Doubt sets out the playbook taken by large industries to undermine critics of their hegemony. When big tobacco was being criticised for causing lung cancer by researchers, it funded researchers who sewed doubt in this hypothesis by pointing to asbestos, stress, etc, anything other than tobacco which might cause lung cancer.
The same playbook was used by fossil fuel companies: as climate scientists started pointing the finger at this industry for driving climate change, scientists associated with industry put out arguments sewing doubt: temperatures natural vary, humans couldn’t be doing it, etc.
This is the identical playbook adopted by the pharmaceutical industry and its supporters when it comes to obscuring the harm of their products. Antidepressant withdrawal isn’t caused by stopping antidepressants, they say, it is caused by patient’s expectations of worsening (nocebo effects), their mental health condition returning, other diseases that co-incidentally occur at the same point (functional neurological disorder) and short-term withdrawal studies show that there is no real issue, etc.13,14
There is an absurdity to painting academics, many of whom are paid by one of the largest industries in the world as representing unimpeachably pure science and Joanna and a bunch of her academic colleagues (including me) as the ‘merchants of doubt’. Of course some of the scientists who defend the efficacy or minimise the harms of antidepressants are not paid by industry, but other interests, such as professional status, are also at play.
I would strongly encourage Jack and anyone reading his essay to go and read criticisms of antidepressant efficacy before jumping to conclusions that anyone putting forward a criticism of the current consensus must be mischieviously motivated.
The current (and poorly examined) consensus on the relative safety and effectiveness of antidepressants in the long-term has led to an avalanche of harm that can be seen spilling out onto social media, newspaper articles, government inquiries, parliamentary groups and, increasingly, concrete NHS projects and directives. Rather than expending further energy trying to shoot (and silence) some of the messengers it would be better for patients if psychiatrists examined the reality of what is occurring to patients and stopped deriving false reassurance from short term studies centrally concerned with commercial objectives.
References available at: mhorowitz.substack.com/p/unexamined-a…
Merchants of Psychiatric Doubt
Why a small group of researchers diverged from their peers on the science of antidepressants
A guest post by @jack_goulder
psychiatrymargins.com/p/merchants-of…
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Sam Hall retweeted
Thank you for setting the record straight. We did not, as accused, misrepresent the serotonin paper as demonstrating that antidepressants are not effective, although this is something I have explored in other research. 1/2
I've responded briefly to Jack's blog here: mhorowitz.substack.com/p/unexamined-a…
The two major problems with Jack Goulder’s blog (and the paper on which it is based) is, one, that Jack is working from the unquestioning (and largely unexamined) assumption that antidepressants work and anyone who suggests otherwise must have mischievous motivation. And two, he has misrepresented what we have said about our umbrella review.
Jack said to me tellingly in an email:
“I should be clear that my academic background is in history and social science, not epidemiology or pharmacology. I’m not sure I’m qualified to give a detailed analysis of the subtleties of this quite vast literature!”
So without engaging with the debate about efficacy in any meaningful way he has embarked on what sounds like a year-long project on the premise that ‘the drugs work because senior people in my field agree they do’ and that he saw a young woman (with a different condition to the literature he is commenting on) improve with antidepressants ‘after a few months, and with the help of therapy too.’
This is not how science works. I sent him a very clear explanation of the issues with antidepressant efficacy written by a Cochrane group in Denmark – who I’m sure have never read Szasz! – published in the BMJ Open but he seems not to have read this: bmjopen.bmj.com/content/9/6/e0…
To just briefly re-state the issues with the Cipriani review on antidepressants (which provides the basis of Jack and other’s unshakeable belief in the efficacy of these drugs): presenting response rates inflates the small absolute differences between antidepressant and placebo.1 This difference is 2 points on a 52 point depression scale.2 This lies below any analysis of what constitutes a clinically important difference (rather than just a statistically significant difference).3,4 See figure above to illustrate some of these elements. These studies only examine effects at 8 weeks, whilst people take these drugs for years.5 Even the small effects at 8 weeks are likely to wear off due to tolerance – the corollary of any drug that causes withdrawal.6
There are also unblinding effects – people who know they are on the drugs have raised expectations which improve mood and these expectations inflate the apparent effects of antidepressants in placebo-controlled trials.7 For example, in an analysis of the TADS study treatment guess had a substantial effect on outcome, while actual treatment group (antidepressant or placebo) did not.7 The Stone et al meta-analysis did not refute the role of unblinding as Jack suggests, it merely notes that the trials it included did not test the integrity of the double blind design (Stone writes “We cannot fully exclude the possibility that the effects of the drugs are accounted for by functional unblinding”). 8
There is also massive publication bias.9 The studies which find 15% of people benefit at an 8 week time point suffer from all the same limitations as above.8 And if there is a small pharmacological effect in the short term from this class of medication it leaves the question of the utility – or the ethics – of giving people drugs that numb their emotions when they are distressed,10 especially with the risk that for a portion of them this numbing does not wear off when the drugs are stopped.11,12 Jack’s piece ignores almost all of these issues.
A central part of this argument is that Joanna and I put out a press release arguing that our paper had demonstrated antidepressants are ineffective. Notably he does not quote the lines from the press release in his blog or the paper – remarkable when this is a key part of his argument.
Of course the reason he does not quote this is because his assertion is false. We don’t anywhere say in our draft press release that we have demonstrated in our umbrella review of the role of serotonin in depression that we have demonstrated that antidepressants are not effective. The closest we come is when we say: “Therefore, this research calls into question reasons for the use of antidepressants.” The research does indeed undermine a common reason for the prescription of antidepressants.
I think what is most unsettling about this piece is that Jack has inverted the work of Naomi Oreskes. Her work and her book Merchants of Doubt sets out the playbook taken by large industries to undermine critics of their hegemony. When big tobacco was being criticised for causing lung cancer by researchers, it funded researchers who sewed doubt in this hypothesis by pointing to asbestos, stress, etc, anything other than tobacco which might cause lung cancer.
The same playbook was used by fossil fuel companies: as climate scientists started pointing the finger at this industry for driving climate change, scientists associated with industry put out arguments sewing doubt: temperatures natural vary, humans couldn’t be doing it, etc.
This is the identical playbook adopted by the pharmaceutical industry and its supporters when it comes to obscuring the harm of their products. Antidepressant withdrawal isn’t caused by stopping antidepressants, they say, it is caused by patient’s expectations of worsening (nocebo effects), their mental health condition returning, other diseases that co-incidentally occur at the same point (functional neurological disorder) and short-term withdrawal studies show that there is no real issue, etc.13,14
There is an absurdity to painting academics, many of whom are paid by one of the largest industries in the world as representing unimpeachably pure science and Joanna and a bunch of her academic colleagues (including me) as the ‘merchants of doubt’. Of course some of the scientists who defend the efficacy or minimise the harms of antidepressants are not paid by industry, but other interests, such as professional status, are also at play.
I would strongly encourage Jack and anyone reading his essay to go and read criticisms of antidepressant efficacy before jumping to conclusions that anyone putting forward a criticism of the current consensus must be mischieviously motivated.
The current (and poorly examined) consensus on the relative safety and effectiveness of antidepressants in the long-term has led to an avalanche of harm that can be seen spilling out onto social media, newspaper articles, government inquiries, parliamentary groups and, increasingly, concrete NHS projects and directives. Rather than expending further energy trying to shoot (and silence) some of the messengers it would be better for patients if psychiatrists examined the reality of what is occurring to patients and stopped deriving false reassurance from short term studies centrally concerned with commercial objectives.
References available at: mhorowitz.substack.com/p/unexamined-a…
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Sam Hall retweeted
Why are there no data to support toxic drug reactions being misdx as #FND? @dsowens17 drives a coach and horses through that, frankly, disingenuous argument:
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Sam Hall retweeted
🚨 If you've been harmed by a medication, please take a few minutes this week to formally report your experience. An estimated 94% of side effects go unreported.
November 2–8 marks #MedSafetyWeek, a global campaign encouraging patients and healthcare professionals around the world to report suspected adverse drug reactions to their national regulatory agencies.
At Moral Medicine, we've interviewed countless people whose lives have been devastated by persistent side effects from medications, including those living with Post-Finasteride Syndrome (PFS), Post-SSRI Sexual Dysfunction (PSSD), and Post-Accutane Syndrome (PAS).
While sharing these stories is critical for raising awareness, formally reporting these adverse reactions is another important step toward greater recognition, research, and accountability.
If you've experienced lasting harm from a medication and haven't formally reported it, we strongly encourage you to do so.
🌎 HOW TO REPORT:
🇺🇸 United States: FDA MedWatch
fda.gov/medwatch
🇬🇧 United Kingdom: MHRA Yellow Card
yellowcard.mhra.gov.uk
🇪🇺 European Union: Find your country's reporting authority through the European Medicines Agency:
ema.europa.eu/en/about-us/wh…
🌎 Other countries: Contact your national medicines regulatory authority to submit a suspected adverse reaction report.
Need additional help?
SIDEfxHUB has also put together a free, step-by-step reporting guide to help patients find their national regulatory authority and navigate the reporting process:
sidefxhub.com/medsafetyweek/
These reports help regulatory agencies identify safety concerns, investigate patterns, and better understand the risks associated with medications.
Our stories deserve to be heard, our injuries deserve to be documented, and patients deserve informed consent.
Please consider sharing this post with others who have experienced medication-induced harm. If you've already submitted a report, encourage someone else to do the same.
Every report matters.
#MedSafetyWeek #MoralMedicine #PFS #PSSD #PAS #PatientSafety #InformedConsent
November 2–8 marks #MedSafetyWeek, a global campaign encouraging patients and healthcare professionals around the world to report suspected adverse drug reactions to their national regulatory agencies.
At Moral Medicine, we've interviewed countless people whose lives have been devastated by persistent side effects from medications, including those living with Post-Finasteride Syndrome (PFS), Post-SSRI Sexual Dysfunction (PSSD), and Post-Accutane Syndrome (PAS).
While sharing these stories is critical for raising awareness, formally reporting these adverse reactions is another important step toward greater recognition, research, and accountability.
If you've experienced lasting harm from a medication and haven't formally reported it, we strongly encourage you to do so.
🌎 HOW TO REPORT:
🇺🇸 United States: FDA MedWatch
fda.gov/medwatch
🇬🇧 United Kingdom: MHRA Yellow Card
yellowcard.mhra.gov.uk
🇪🇺 European Union: Find your country's reporting authority through the European Medicines Agency:
ema.europa.eu/en/about-us/wh…
🌎 Other countries: Contact your national medicines regulatory authority to submit a suspected adverse reaction report.
Need additional help?
SIDEfxHUB has also put together a free, step-by-step reporting guide to help patients find their national regulatory authority and navigate the reporting process:
sidefxhub.com/medsafetyweek/
These reports help regulatory agencies identify safety concerns, investigate patterns, and better understand the risks associated with medications.
Our stories deserve to be heard, our injuries deserve to be documented, and patients deserve informed consent.
Please consider sharing this post with others who have experienced medication-induced harm. If you've already submitted a report, encourage someone else to do the same.
Every report matters.
#MedSafetyWeek #MoralMedicine #PFS #PSSD #PAS #PatientSafety #InformedConsent
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Sam Hall retweeted
Since quitting the zoloft, my dreams have been so vivid and exciting! But I am no longer so numb and tired that I want to sleep my life away. They're a treat at the end of a day of feeling my emotions to the fullest and bejng present.
I was on SSRIs for more than half of my life. I have spent more time on them than off, and I am onky 28. I can't wait to discover more of what I have been missing.
Brain zaps have been becoming increasingly manageable.
I was on SSRIs for more than half of my life. I have spent more time on them than off, and I am onky 28. I can't wait to discover more of what I have been missing.
Brain zaps have been becoming increasingly manageable.
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Sam Hall retweeted
Latest piece from @DrDavidHealy on the link between SSRI use and FND (Functional Neurological Disorder)
"A key thing is to ensure FND does not get diagnosed until the diagnostician has ruled out the possibility of a prior drug induced toxic state."davidhealy.org/functional-fas…
"A key thing is to ensure FND does not get diagnosed until the diagnostician has ruled out the possibility of a prior drug induced toxic state."davidhealy.org/functional-fas…
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Sam Hall retweeted
Not sure what’s happening with my body right now. Akathisia has come back full force after staying at a low level for the past year. I’ve managed about two hours’ sleep over the last three days and spent them upright on the sofa rocking because I can’t stay still in bed. It feels like someone’s holding a cattle prod to my spine. My legs and hands feel like severed electrical cables, my body is pumping adrenaline nonstop as if I’m being chased by an axe murderer and I’m nauseous to the point of dry heaving. It’s destroying me.
I thought this was behind me, but it’s returned completely out of the blue. I’m terrified and have no idea what triggered it or whether it’s simply part of the long, uneven healing from protracted withdrawal. I haven’t changed any doses for two years. I don’t know if the remaining drugs are irritating my system through kindling or if this is just how recovery works for some people. It’s an awful place to be when you don’t know which way to turn.
I feel like I’m fighting for my life again. Hoping this eases soon.
I thought this was behind me, but it’s returned completely out of the blue. I’m terrified and have no idea what triggered it or whether it’s simply part of the long, uneven healing from protracted withdrawal. I haven’t changed any doses for two years. I don’t know if the remaining drugs are irritating my system through kindling or if this is just how recovery works for some people. It’s an awful place to be when you don’t know which way to turn.
I feel like I’m fighting for my life again. Hoping this eases soon.
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Sam Hall retweeted
The effectiveness of antidepressants revisited
One in every seven patients experiences significant relief, or patients experience an average benefit of just 1.97 points on a 52-point depression scale. Which is true?
Both figures are frequently cited, but they tell very different stories.
The first comes from the Number Needed to Treat (NNT), commonly estimated at around 7 for antidepressants. This is often interpreted as meaning that one in seven patients experiences a substantial benefit from the drug.
The second comes from analyses of clinical trial data showing that antidepressants outperform placebo by an average of approximately 2 points on the 52-point Hamilton Depression Rating Scale.
So how can both be true?
The problem lies partly in how treatment response is measured.
NNT is typically calculated using a threshold of 50% symptom reduction. Someone whose symptoms improve by 49% is classified as a non-responder, while someone improving by 50% is classified as a responder.
This means that relatively small differences in average symptom improvement can produce apparently impressive differences in response rates.
Crucially, an NNT of 7 does NOT establish that one in seven patients experiences a substantial pharmacological benefit. It tells us that one additional patient crosses a particular response threshold for every seven treated compared with placebo.
We still don’t know how many patients experience a genuinely large improvement caused by the antidepressant, rather than improvement they would have experienced anyway.
Yet the NNT is routinely presented in ways that suggest we do.
When communicating antidepressant efficacy, shouldn’t we be telling patients about the actual magnitude of the average benefit, rather than relying on statistics that can make relatively small effects appear much more substantial?
One in every seven patients experiences significant relief, or patients experience an average benefit of just 1.97 points on a 52-point depression scale. Which is true?
Both figures are frequently cited, but they tell very different stories.
The first comes from the Number Needed to Treat (NNT), commonly estimated at around 7 for antidepressants. This is often interpreted as meaning that one in seven patients experiences a substantial benefit from the drug.
The second comes from analyses of clinical trial data showing that antidepressants outperform placebo by an average of approximately 2 points on the 52-point Hamilton Depression Rating Scale.
So how can both be true?
The problem lies partly in how treatment response is measured.
NNT is typically calculated using a threshold of 50% symptom reduction. Someone whose symptoms improve by 49% is classified as a non-responder, while someone improving by 50% is classified as a responder.
This means that relatively small differences in average symptom improvement can produce apparently impressive differences in response rates.
Crucially, an NNT of 7 does NOT establish that one in seven patients experiences a substantial pharmacological benefit. It tells us that one additional patient crosses a particular response threshold for every seven treated compared with placebo.
We still don’t know how many patients experience a genuinely large improvement caused by the antidepressant, rather than improvement they would have experienced anyway.
Yet the NNT is routinely presented in ways that suggest we do.
When communicating antidepressant efficacy, shouldn’t we be telling patients about the actual magnitude of the average benefit, rather than relying on statistics that can make relatively small effects appear much more substantial?
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Sam Hall retweeted
"Withdrawal symptoms following long-term SSRI use appear far more pervasive and serious than previously realised. Now medical bodies are rethinking how and when to stop taking them"
buff.ly/RMpiyBd
buff.ly/RMpiyBd
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Sam Hall retweeted
Dr. Aftab presents a handful of theories of how antidepressants "work", thus confirming that nobody knows while still implying that they're miracle drugs.
Truth: Some like the effects, some don't, it's probably 50-50. For many, they don't do anything but generate adverse effects.
Truth: Some like the effects, some don't, it's probably 50-50. For many, they don't do anything but generate adverse effects.
In my latest “Therapeutic Window” piece for the @nytimes, I discuss our current scientific understanding of how antidepressants work
(Gift link but NYT requires an email sign up to read for free)
nytimes.com/2026/10/27/sci…
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Sam Hall retweeted
We are pleased to pass along information on this FREE ONLINE EVENT hosted by SafeMeds Ηellas (@aws_greece)
SafeMeds Hellas 1st Forum:
WITHDRAWAL SYNDROME DURING ANTIDEPRESSANT REDUCTION/DISCONTINUATION
We are very happy to invite you to the 1st Forum of SafeMeds Hellas, a free wal syndrome during antidepressant reduction and discontinuation. The Forum brings together scientific research, clinical practice and the voices of people with lived experience.
Our keynote speaker is Dr Mark Horowitz. All talks will be pre-recorded and made available a few days before the Forum, so you can watch them in advance and at your own pace. On Saturday, we will hold the panel discussions.
Date: Saturday 7 November 2026, 15:30 Greece time (EET) / 13:30 GMT/UTC
Format: online
Cost: free to attend
Language: all content will be subtitled
This is the first Forum we have organised, and your support would mean a great deal to us.
Please register and share it with anyone who might be interested.
Register here: buff.ly/yy51Oc7
SafeMeds Hellas 1st Forum:
WITHDRAWAL SYNDROME DURING ANTIDEPRESSANT REDUCTION/DISCONTINUATION
We are very happy to invite you to the 1st Forum of SafeMeds Hellas, a free wal syndrome during antidepressant reduction and discontinuation. The Forum brings together scientific research, clinical practice and the voices of people with lived experience.
Our keynote speaker is Dr Mark Horowitz. All talks will be pre-recorded and made available a few days before the Forum, so you can watch them in advance and at your own pace. On Saturday, we will hold the panel discussions.
Date: Saturday 7 November 2026, 15:30 Greece time (EET) / 13:30 GMT/UTC
Format: online
Cost: free to attend
Language: all content will be subtitled
This is the first Forum we have organised, and your support would mean a great deal to us.
Please register and share it with anyone who might be interested.
Register here: buff.ly/yy51Oc7
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