Review of Studies Finds Antidepressants Not Reliably Better Than Sugar Pills

Are Antidepressants Just Placebos With Side Effects?

Reviews of large numbers of studies on antidepressants – including studies the drug companies never published because they did not have positive outcomes – continue to show that improvement in patients given antidepressants is due largely, if not entirely, to the placebo effect and not the drugs.

In 2010, Irving Kirsch, Ph.D., professor of psychology at the University of Hull in England and author of “The Emperor’s New Drugs: Exploding the Antidepressant Myth,” published an article on the conclusions he and his colleagues reached after reviewing data the drug companies had sent to the FDA.  The data, obtained by using the Freedom of Information Act, included results that had never been published because the results were not favorable to the drugs the companies were testing.

Kirsch termed the results of the review “shocking.” His group’s meta-analysis (the analysis of many clinical trials on the same subject – in this case, antidepressants) found that placebos – sugar pills – are 82% as effective as antidepressants.  However, they further found that even this “relatively small difference between drugs and placebos might not be a real drug effect at all.  Instead, it might be [nothing more than] an enhanced placebo effect.”

The placebo effect refers to perceived or actual improvement in health that does not come from the treatment the patient is receiving, which may be a dummy pill, but from the patient’s belief that the treatment will help.

The FDA only requires two clinical trials that show any statistical difference between drug and placebo in order to approve a drug – even if a much larger number of studies failed to show positive results.  And the positive result can be so small that it makes no real difference in people’s lives.  The FDA does not require results to be clinically significant, just statistically significant.

Kirsch’s results are supported by another group of researchers who reviewed four meta-analyses of clinical trials on antidepressants that were submitted to the FDA.

Their conclusion, published in Psychotherapy and Psychosomatics last year, stated that “antidepressants are only marginally efficacious [effective] compared to placebos,” and even this modest benefit might be inflated by “profound publication bias.”  Publication bias means the tendency of researchers and publications to publish results that are favorable for the drugs being tested and to hide or reject results that are unfavorable, thereby shaping both professional and public opinion by unscientific means.

These same researchers also analyzed the data from STAR*D (Sequenced Treatment Alternatives to Relieve Depression), the largest antidepressant effectiveness trial ever conducted.  They found that “the effectiveness of antidepressant therapies was probably even lower than the modest one reported by [that study’s] authors, with an apparent progressively increasing dropout rate across each study phase.”  The progressively increasing dropout rate, as more and more participants dropped out of the study because of adverse effects they experienced, means the study became more and more biased towards a favorable outcome.

The researchers found results on the antidepressant studies to be so inflated that they call for a complete reconsideration of the use of antidepressants: “The reviewed findings argue for a reappraisal of the current recommended standard of care of depression.”

Their concern is shared by Marcia Angell, former editor-in-chief of The New England Journal of Medicine and now a senior lecturer in social medicine at Harvard Medical School.  In the first part of her recent, two-part essay in The New York Review of Books,  she writes about the disturbing extent to which the pharmaceutical companies that sell psychoactive drugs – through both legal and illegal marketing and “what many people would describe as bribery” – have come to determine the “diagnosis” and treatment of mental illness.

In the second part of her essay, she calls for more research into alternatives to antidepressants:  “More research is needed to study alternatives to psychoactive drugs, and the results should be included in medical education.”

Indeed.  If antidepressants are no more effective than placebos, but come at a great cost and expose individuals to a lengthy and growing list of devastating and even life-threatening side effects, including deepening and chronic depression and suicide, it only makes sense that diet, nutritional supplements, exercise, and meaningful activities be explored as alternatives.

Just as important, depression is very often a mental symptom of an undiagnosed, untreated physical condition.  A complete physical examination by a non-psychiatric physician should always be done to look for underlying physical conditions before antidepressants or other psychotropic drugs are prescribed.

Individuals currently taking antidepressants are cautioned against suddenly discontinuing them.  No one should stop taking any psychiatric drug without the advice and supervision of a competent medical doctor.

If you or someone you know has been harmed by antidepressants or other psychiatric drugs, you can contact us privately by clicking here or by calling 303-789-5225.  All information will be kept in the strictest confidence.  We also welcome your comments below.

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Pueblo City Schools To Correct Non-Compliance With State Law Safeguarding Children

Two months after the Citizens Commission on Human Rights of Colorado (CCHR) first contacted the office of the Superintendent of Pueblo City Schools, the school district will begin to take action on adopting policy to safeguard schoolchildren that has been required by state law since 2003.

(See “Pueblo School District Fails To Explicitly Prohibit Teachers From Pushing Psychiatric Drugs.”)

C.R.S. 22-32-109(1)(ee) requires school district Boards of Education to adopt policy that explicitly “prohibit[s] school personnel from recommending or requiring the use of a psychotropic drug for any student.”  The law further mandates that behavioral testing of students requires prior written permission from the parents and prior written disclosure to the parent of what will be done with the test results.

The response from the office of Superintendent Maggie Lopez to CCHR’s initial public records request was slow and vague.  CCHR then sent a complaint to the president of the district’s Board of Education, in keeping with guidelines set by the Colorado Department of Education.  A complete response was received from the school district today.

The first reading of policy revisions containing the required statutory language will occur at the August 4 Board meeting, according to Greg Sinn in the district’s public relations office.  The third and final reading necessary for adoption is expected in September.

Psychotropic (mind-altering) drugs carry dangerous, even life-threatening side effects, especially for children.  (Adverse reactions to psychiatric drugs, as detailed in research studies, warnings from international regulatory authorities and reports to the FDA, can be accessed through CCHR International’s psychiatric drug side effect search engine.)

Psychiatric drugs also do not address the real, underlying problem(s) the child is experiencing, which may be a lack of additional instructional help, poor nutrition, or an undiagnosed physical condition.

Due to CCHR’s efforts, Pueblo City Schools becomes the twenty-first Colorado school district to date taking steps to remedy a long-standing non-compliance with this state law.

If you or someone you know has been pressured by school personnel to put a child on psychiatric drugs, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Pueblo School District Fails To Explicitly Prohibit Teachers From Pushing Psychiatric Drugs

Policy Protecting Schoolchildren Has Been Required By State Law Since 2003

Pueblo City Schools is apparently in no hurry to adopt policy safeguarding children that has been required by state law since 2003.

An examination of Pueblo City Schools Board policy by the Citizens Commission on Human Rights of Colorado (CCHR) found that the School Board is in violation of state law by not having adopted policy explicitly prohibiting school personnel from recommending or requiring psychiatric drugs for any student.

CCHR first brought the noncompliance to the attention of the office of Superintendent Maggie Lopez on June 6, following guidelines set by the Colorado Department of Education.  Since that time, agendas for the school district’s Board of Education meetings – including the meeting scheduled for this evening – have not included any mention of action on adoption of this policy.

Several readings of a policy are required at Board of Education meetings before it can be adopted for Pueblo City Schools.  Thus, it appears that some 23,000 schoolchildren in the district will be starting yet another school year without this statutory protection in place.

C.R.S. 22-32-109(1)(ee) requires school district Boards of Education to adopt policy “to prohibit school personnel from recommending or requiring the use of a psychotropic drug for any student.”

The law further requires policy that “School personnel shall not test or require a test for a child’s behavior without prior written permission from the parents or guardians or the child and prior written disclosure as to the disposition of the results or the testing therefrom.”

The law was passed by the Colorado State Legislature eight years ago to protect against teachers, principals and other school personnel pressuring parents to put their children on psychiatric drugs.  These mind-altering drugs carry dangerous, even life-threatening side effects.  (Adverse reactions to psychiatric drugs, as detailed in research studies, warnings from international regulatory authorities and reports to the FDA, can be accessed through CCHR International’s psychiatric drug side effect search engine.)

Psychiatric drugs also do not address the real, underlying problem(s) the child is experiencing, which may be a lack of additional instructional help, poor nutrition, or an undiagnosed physical condition.

CCHR has sent Colorado Open Records Act requests to school districts throughout the state, requesting copies of the policy or policies that comply with this state law.

To date, CCHR has identified 21 school districts that did not have Board policy with the clear language of C.R.S. 22-32-109(1)(ee).  Twenty of the 21 districts indicated to CCHR that steps were immediately being taken to remedy the long-standing non-compliance with state law.

Only Pueblo City Schools has been vague about when it will adopt the required statutory language.

Pueblo is home to the psychiatric drugging center known as the Colorado Mental Health Institute at Pueblo.

Because a response from the superintendent was unclear as to when Pueblo Schools will act to bring its policy into compliance with the 2003 law, CCHR forwarded a complaint directly to the president of the Pueblo City Schools Board of Education, again following guidelines set by the Colorado Department of Education.

If you or someone you know has been pressured by school personnel to put a child on psychiatric drugs, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Pueblo DA Skeptical of Changes At Colorado Mental Health Institute at Pueblo

Says Whole Scrapping Of The Culture Is Needed.

Pueblo County District Attorney Bill Thiebaut publicly expressed his skepticism of claims by the Colorado Department of Human Services that improvements have occurred at the Colorado Mental Health Institute at Pueblo (CMHIP) in the wake of a patient death there last August.

According to the Pueblo Chieftain, Thiebaut said “I don’t have a lot of confidence that there’s been a change out there.”  He went on to say that change would require a whole scrapping of the culture at CMHIP.

“We have a culture that has permeated the institution for years,” Thiebaut said.

That culture was the focus of a report issued by a Pueblo County grand jury that investigated the August 2010 death of patient Troy Geske.  The 41-year-old, who was obese and suffering from a respiratory infection, suffocated while being restrained face down and left unattended in a seclusion room at the facility for refusing to take psychiatric drug(s) prescribed to him.  See a summary of that report in our article “You Be The Judge: Pueblo Grand Jury Returns Findings In Death of State Hospital Patient.”

“The grand jury said things need to change from the top down,” Thiebaut continued.

Geske had been readmitted to CMHIP in July 2010 because he was experiencing mental symptoms that included auditory hallucination, depression, worsening confusion and aggressive behavior.

All of these behaviors are side effects of psychiatric drugs.  Geske’s ultimate death while under the control of CMHIP staff may well have been the direct result of the psychiatric drugs he was prescribed by psychiatrists at CMHIP – drugs that he was struggling to refuse at the time of his death, drugs he may well have known were destroying him.

Adverse reactions to psychiatric drugs, as detailed in research studies, warnings from international regulatory authorities and reports to the FDA, can be accessed through CCHR International’s psychiatric drug side effect search engine.

   If you have experience with “the culture” at CMHIP, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225. All information will be kept in the strictest confidence. We welcome your comments on this article below.

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Chance of Autism Doubles with Antidepressant Use During Pregnancy

A study just published in the Archives of General Psychiatry found that the odds of having an autistic child doubled for mothers who took newer antidepressants known as SSRIs (selective serotonin reuptake inhibitors) during the year before delivery.

SSRIs include Prozac, Zoloft, Celexa and Lexapro, among others.

The study found that the rate was greater than two autistic children per 100 mothers on SSRIs, with the rate higher still if mothers took SSRIs in the first trimester of their pregnancy.

The research was undertaken because the rising incidence of autism in recent years parallels a rise in the use of SSRIs during pregnancy.

A second study just released also suggests that environmental factors, including prenatal conditions, play a significantly larger role in autism.

Dr. Joseph Coyle, editor-in-chief of the psychiatry journal, called the two studies “game changers.”

Clara Lajonchere, an author of one of the studies and vice president of clinical programs for the research and advocacy organization Autism Speaks, said that “much more emphasis is going to be put on looking at prenatal and perinatal [around the time of childbirth] factors with respect to autism susceptibility.”

Pregnant women currently taking SSRIs are cautioned against suddenly discontinuing them.  No one should stop taking any psychiatric drug without the advice and supervision of a competent medical doctor.

If you or someone you know gave birth to a child with birth defects or other problems after taking psychiatric drugs during pregnancy, we want to talk to you.  You can contact us privately by clicking here or by calling 303-789-5225.  All information will be kept in the strictest confidence.  We welcome your comments on this article below.

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Elise Sannar: Did The Colorado Medical Board Discipline This Psychiatrist Appropriately?

Part of the ongoing series:
You Be The Judge

The state medical boards of Colorado and California handled the professional misconduct of an Aurora psychiatrist very differently.

Psychiatrist Elise Sannar signed stipulations with the Colorado State Board of Medical Examiners in 2007 and 2009, in which she admitted professional misconduct.  Because she was licensed in both Colorado and California, her conduct was the subject of reviews by the medical boards of both states.

According to the Colorado State Board of Medical Examiners’ Second Stipulation and Final Agency Order dated July 16, 2009 and available on the Colorado Department of Regulatory Agencies website, psychiatrist Sannar admitted to the following facts:

  • From July 2005 to July 2006, she took a leave of absence from a residency program in psychiatry at the University of Colorado Health Sciences Center so she could work as a forensic psychiatrist at the Colorado Mental Health Institute at Pueblo (CMHIP).
  • In August 2005, patient J.M., an inmate, was transferred to CMHIP with a legal status of Incompetent to Proceed in court with criminal charges against him.  Sannar was his treating psychiatrist from roughly the time he arrived at CMHIP through November 2005.
  • While in treatment with psychiatrist Sannar, J.M. informed her that he had developed romantic feelings for her.  Sannar did not transfer J.M. to another psychiatrist for treatment, as was required by generally accepted standards of practice.
  • J.M. left CMHIP in November 2005 with a legal status of Competent to Proceed, after which he was tried on criminal charges and ultimately sentenced to four years in prison.
  • Within six months of the end of treating him at CMHIP, Sannar began a romantic relationship with J.M., which continued until approximately February 2007.  The details were not specified in the public documents.
  • Sannar admits through the documents she signed that she “was aware at all relevant times of the ethical and medical impropriety of beginning and maintaining such a relationship with a patient.”

With a finding of unprofessional conduct, the Colorado State Board of Medical Examiners has a range of disciplinary actions it can take, including suspending, revoking, placing on probation or otherwise restricting, limiting or placing conditions on a license.

What did the Colorado Medical Examiners Board do?  It gave her five years probation, dating from November 16, 2007, with certain treatment and monitoring required for Sannar and certain restrictions on her treatment of patients, as detailed in the Second Stipulation and Final Agency Order.  Her license remained active.

What did the Medical Board of California do with the same set of facts and admissions from Sannar?  It got a signed Stipulation for Surrender of License from her.  (The document can be accessed on the Medical Board of California website by entering license #96357.)  Sannar can no longer practice as a psychiatrist in the state of California.

Last month, the Colorado State Board of Medical Examiners took yet another action, this time to terminate Sannar’s Second Stipulation after just 3½ years of probation, apparently on Sannar’s petition for early termination.  Her license is now active without any conditions in the state of Colorado.

According to her online Physician Profile, Sannar is currently employed as a psychiatrist by the Children’s Hospital in Aurora, and has faculty affiliations at both Children’s Hospital and the University of Colorado Hospital.

What do you think?  Did the Colorado State Board of Medical Examiners act appropriately under the circumstances?

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Suspect In Gruesome Murder Reportedly Has History Of Psychiatric Treatment

Part of the ongoing series: Killers On Psych Drugs –
Psych-Drugged Accused Or Convicted Killers

Add another grisly killing to the long list of sudden, violent crimes committed by individuals with a history of taking psychiatric drugs.

Edward Romero, 27, is charged with killing a 16-year-old girl as she walked home from a party, after which he cut up her body and packed it away in a container in his garage.  He recently pleaded not guilty by reason of insanity to a charge of first-degree murder in Denver District Court.  According to the Denver Post, a judge had earlier ordered Romero to keep taking psychiatric medication.

While we don’t know the details of those psychiatric drugs, we do know that the current, rising wave of violence that is rocking our homes, schools, and communities parallels the soaring use of psychiatric drugs in American society.

Research studies, international regulatory authority warnings, and reports to the FDA, have linked the use of, and/or the too-rapid withdrawal from, numerous psychiatric drugs to violent behavior, including homicide.

High-profile Colorado killings with links to psychiatric drugs include Stephanie Rochester smothering her 6-month-old son in Superior in 2010.  She has pleaded not guilty by reason of insanity.  She reportedly was taking the antidepressant Zoloft at the time, and had intended to take her own life.

Rebekah Amaya, of Lamar, was also reportedly on antidepressants when she drowned her 4-year-old daughter and 6-month-old son in 2003.  She was found not guilty by reason of insanity in 2004.

Of course, the granddaddy of Colorado psychiatric drug-related violence is the deadly assault on Columbine High School in 1999.  Shooter Eric Harris was taking the antidepressant Luvox at the time he and Dylan Klebold opened fire at Columbine High School, killing 12 students and a teacher and wounding 26 others before killing themselves.  Harris reportedly became obsessed with homicidal and suicidal thoughts within weeks of starting to take antidepressants.  (See The Real Lesson of Columbine: Psychiatric Drugs Induce Violence.”)

At least one public report exists from a friend of Klebold, who says she witnessed him taking the antidepressants Paxil and Zoloft and urged him to come off the drugs.  Officially, Klebold’s medical records remain sealed.

Both the U.S. FDA and Health Canada have issued warnings that many antidepressants are linked to a greater risk of suicide, aggression and violence.

CCHR International’s documentary DVD, “Psychiatry’s Prescription for Violence,” containing interviews with experts, parents, victims, and a killer himself, can be viewed online by clicking here.

If you or someone you know has had suicidal or homicidal thoughts or committed sudden violent acts while taking or in withdrawal from psychiatric drugs, you can contact us privately by clicking here or by calling 303-789-5225.  All information will be kept in the strictest confidence.   We welcome your comments on this article below.

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State Psychiatric Facilities Abuse Emergency Drugging

State Audit Finds Lack of Documentation Supporting Involuntary Drugging Of Patients

Patients in the state psychiatric facilities at Pueblo and Fort Logan were drugged against their will without sufficient documentation to justify the action, according to an audit report just released by the Colorado Office of the State Auditor.

The review of some patient files at the Colorado Mental Health Institutes at Pueblo and Fort Logan found that a number of them “lacked sufficient clinical documentation to substantiate that a psychiatric emergency existed warranting an emergency medication order.”

Additionally, the audit uncovered patients whose legal rights were violated when they were involuntarily drugged on a claimed emergency basis for more than 72 hours without the proper documentation of a second opinion and/or a written request for a court hearing, as required by state law.

The report further criticized the psychiatric institutions for lacking documentation to substantiate that the condition of patients warranted psychiatrists’ petitions to courts for, or their continued use of, court-ordered involuntary drugging.

Some patients’ current medications were not discontinued before they were involuntarily drugged on a claimed emergency basis, which resulted in patients having two sets of drugging orders in effect at the same time, with an increased risk to them of serious side effects.

Significantly Higher Error Rates in Administering Drugs

Average error rates in administering drugs in 2010 were significantly higher at the Institutes than the average rate for a comparable peer group of facilities.  Specifically, Fort Logan averaged 4.50 errors per 100 drugging episodes, and Pueblo 4.93, as compared to an average of 2.71 in facilities in the peer group.

Further, there were cases in which the psychiatrist ordered two or three psychiatric drugs, including antipsychotics, on an as-needed basis for the same condition without sufficient documentation substantiating the need for multiple medications.

According to the report, several patients were found to have been put on the drug clozapine, an antipsychotic that has a potentially life-threatening side effect, without clear and sufficient documentation that less risky treatments had been tried first.

The psychiatric institutions also failed to do recommended medical follow-up on a number of patients to test for the dangerous side effects of certain antipsychotic drugs, such as the metabolic monitoring recommended by the American Diabetes Association for patients on certain antipsychotic drugs with well-known links to the onset of diabetes.

The facilities were found to have inconsistent guidelines and monitoring protocols for administering high-risk drugs, and in some cases, established guidelines were not followed.

The full audit report, “Psychiatric Medication Practices for Adult Civil Patients, Colorado Mental Health Institutes,” is posted in the June 2011 reports of the Office of the State Auditor.

If you or someone you know has experience with the Colorado Mental Health Institute at Pueblo or Fort Logan, we want to talk to you.  Please contact us privately by clicking here or by calling 303-789-5225.  All information will be kept strictly confidential.  We also welcome your comments below.

 

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Brighton School District 27J In Violation For Eight Years Of State Law Safeguarding Students

An examination of Brighton School District 27J Board policy by the Citizens Commission on Human Rights of Colorado (CCHR) found that until today, the superintendent’s policy did not contain language prohibiting school personnel from recommending or requiring psychiatric drugs for any student, a policy that has been required by state law since 2003.
This means that for the past eight years, some 15,000 children in the district have not been protected by district policy from teachers, principals and other school personnel pressuring parents to put their children on behavioral drugs, especially ADHD drugs, which may endanger their health and mask the real problems students are experiencing in the classroom.
C.R.S. 22-32-109(1)(ee) requires school district Boards of Education to adopt policy “to prohibit school personnel from recommending or requiring the use of a psychotropic drug for any student.” The law further requires policy that “School personnel shall not test or require a test for a child’s behavior without prior written permission from the parents or guardians or the child and prior written disclosure as to the disposition of the results or the testing therefrom.”
One in nine boys between the ages of 6 and 14 in the U.S. is already being treated with ADD/ADHD drugs (methylpenidate). These drugs are amphetamines, which are highly addictive, which lab rats cannot distinguish from cocaine, and which a government study found greatly increase the risk that children taking them will end up on street drugs – especially cocaine. The last thing we need is schools pressuring parents to pressure their doctors to put even more of our kids on these drugs.
In 2006 the U.S. Food and Drug Administration began to require ADD/ADHD drugs to carry the FDA’s strongest, “black-box” warning that the drugs can cause heart attacks, strokes and sudden death. Cardiologist Steven Nissen, on the FDA advisory panel that recommended this warning, explained the urgency of the warning: “This is out-of-control use of drugs that have profound cardiovascular consequences. We have got a potential public health crisis. I think patients and families need to be made aware of these concerns.”
Drugging may make children easier to control, but it comes at the cost of putting children’s health at tremendous risk. It also does not address the real problem the child is experiencing, which may be a lack of additional instructional help, poor nutrition, or an undiagnosed physical condition.
CCHR Colorado brought the policy omission to the attention of Brighton 27J officials early today. District chief legal officer Janet Wyatt reported that district Board policy was revised later in the day to bring it into compliance with state law.
The Brighton Standard Blade covered this story, which is available online to subscribers.

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Denver Post Fails To Address The Role Of Psychiatric Drugs In Suicides

Psychiatric Drugs Are Linked To Worsening Depression and Suicide

A story in today’s Denver Post about suicides in Colorado failed to address a key issue:  How many of these individuals had been taking psychiatric drugs, known to worsen depression and increase the risk of suicide, before they took their own lives?

We know that individuals seeking help from psychiatrists will almost certainly be prescribed one or more psychotropic (mind-altering) drugs because, according to a recent article in the New York Times,drugging is so much faster and more profitable to the psychiatrists than taking the time to listen to their patients’ problems.

We also know that psychiatric drugs are known to cause serious, even life-threatening side effects.  (For international studies and warnings on the dangerous side effects of psychiatric drugs, as well as adverse drug reactions reported to the FDA, go to CCHR International’s psychiatric drug side effects search engine.)

Antidepressants in particular are known to cause worsening depression, birth defects, sexual dysfunction, anxiety, panic attacks, hostility, aggression, psychosis, violence, suicide and many, many other adverse events.  Long-term antidepressant users frequently report that their emotions have been deadened so much that they feel like zombies.

With drugging having become almost the only psychiatric “treatment” available, no wonder the rate of suicides in Colorado has shown no improvement whatsoever in the 22 years for which data is available from the Colorado Department of Public Health and Environment’s online death statistics database.

CCHR International’s award-winning documentary, “Dead Wrong: How Psychiatric Drugs Can Kill Your Child,” is the powerful story of one mother’s quest to understand her child’s suicide.  Six months after her son Matthew died, Celeste Steubing discovered the link between psychiatric drugs and suicide.  Feeling betrayed over having been denied these facts, she testified before the FDA in 2004, along with many other parents whose children had been driven to suicide by antidepressants.  That same year, the FDA issued its strongest, black-box warning that antidepressants can cause suicide, a warning that came 18 months too late for Matthew.  Click here to view the DVD and hear what parents, health experts, drug counselors and doctors have to say about the deadly dangers of psychiatric drugs.

If you have experienced increased depression, thoughts of suicide, or any other adverse side effect while taking a psychiatric drug, report it to the FDA by clicking here.

If you or someone you know has been harmed by psychiatric treatment or psychiatric drugs, you can contact us privately by clicking here or by calling 303-789-5225.  All information will be kept in the strictest confidence.  We also welcome your comments below.

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