#MentalHealth Policy & Service dev #QualityRights #humanrights #CRPD, psychosocial disability. Follow @WHO for official tweets
Geneva, Switzerland
Joined June 2012
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Michelle Funk retweeted
This is certainly the most consequential paper published in child and adolescent psychiatry for the last few years. It shows that the meta-analyses that current child psychiatry guidelines rely on to recommend fluoxetine for depression were skewed by an unbelievable trial (n=40) in Iran which found an effect 15 times larger than the average.
When this trial is removed all meta-analyses find the same as a recent Cochrane analysis which found 'small and unimportant differences.'
The flawed meta-analyses by Zhou and @cipriani in the @TheLancet and Lancet Psychiatry need to be corrected.
And guideline committees need to update their guidance in the context of the harms of these drugs including withdrawal effects, sexual effects and agitation/akathisia and suicidality in a minority of youths exposed to them.
Link below
Michelle Funk retweeted
In an analysis of drug withdrawal to the FDA adverse effects database here were the signals for the 20 drugs with strongest risk of withdrawal. Paroxetine, duloxetine and venlafaxine where in the top 20. Paroxetine was no. 4, above several opioids.
Michelle Funk retweeted
I spoke too quickly - JAMA did publish my comment on why the APA/ASCP should seek to minimise unnecessary harm to patients by collaborating with HHS on the widespread issue of withdrawal from antidepressants, rather than seek to oppose these constructive measures. jamanetwork.com/journals/jam…
JAMA did not print my comment on the JAMA news piece on deprescribing so putting my comments here:
Guidelines for Safe Deprescribing Are Long Overdue in Psychiatry and Should Be Embraced as a Part of High-Quality Prescribing
It is unfortunate that the APA and ASCP have responded so unconstructively to HHS's proposals to improve infrastructure for safe deprescribing through guidelines and reimbursement. Psychiatric training and guidelines have devoted far more attention to starting psychiatric medication than to stopping it safely. A substantial proportion of patients experience severe, prolonged and sometimes disabling withdrawal effects when psychiatric drugs are discontinued according to current practice.[1] More than 100,000 Americans patients belong to online support groups seeking advice on safely stopping psychiatric drugs after inadequate guidance from prescribers. HHS is right to address this unmet clinical need.
It is a strawman to characterise HHS proposals as "restricting" antidepressant prescribing. In many countries, psychological therapies, exercise and other non-pharmacological treatments are routinely and uncontroversially recommended alongside or ahead of antidepressants, and deprescribing guidelines are increasingly being published.[2] It is striking that the clinically neutral term deprescribing - used for decades across medicine - provokes such resistance within psychiatry.
The APA and ASCP also conflate the risks of stopping antidepressants too quickly with the risks of not being on antidepressants. These are different issues. Antidepressants have never been robustly shown to reduce suicide overall [3], so increased suicidality after discontinuation cannot simply be attributed to the absence of treatment. By contrast, withdrawal effects can include severe anxiety, agitation, insomnia and akathisia, which can precipitate suicidal behaviour.[4]
Likewise, relapse-prevention studies are routinely interpreted without acknowledging a major methodological flaw. Most discontinuation trials stop antidepressants over days or weeks, despite increasing evidence that such rapid discontinuation commonly produces withdrawal symptoms. Because these studies do not distinguish withdrawal from relapse, withdrawal symptoms are frequently misclassified as depressive recurrence, exaggerating estimates of relapse prevention.[5] Relapse certainly occurs, but evidence suggests its risk can be reduced by slower, carefully supervised hyperbolic tapering over months.[6] It is therefore misleading to conflate the risks of rapid discontinuation with those of gradual, patient-centred deprescribing.
The recent deprescribing textbook by Stahl and Strawn simply reiterates current practice. It presents relapse-prevention studies without discussing these methodological problems, recommends rapid linear tapers despite growing evidence favouring gradual, hyperbolic tapering, and suggests adding further psychiatric medication when patients struggle, risking misdiagnosis of withdrawal as relapse and contributing to unnecessary polypharmacy.
More than half of Americans (55.9%) have now been prescribed an antidepressant during their lifetime, and one in six adults is currently taking one.[7] In this context, claims of widespread under-treatment are difficult to sustain. Rather than opposing HHS, the APA and ASCP would better serve patients by helping develop evidence-based deprescribing guidelines and improving clinicians' ability to recognise and manage withdrawal safely.
References
[1] Read et al. J Psych Res. 2023.
[2] NICE Depression Guideline. 2022.
[3] Hengartner et al. J Epi Comm Health. 2021
[4] Moncrieff et al. JAD Reports. 2024
[5] Hengartner. Ther Adv Psychopharm. 2020.
[6] Maudsley Deprescribing Guidelines. 2024.
[7] Perlis et al. BMJ Mental Health. 2026.
jamanetwork.com/journals/jam…
Michelle Funk retweeted
I am sharing this here just to counter the demoralisation one can accumulate from listening to the ideological, defensive and often close-minded psychiatrists on this platform. In the broader world, many clinicians are open to learning about safe deprescribing, and issues with antidepressants prescribing. This is a letter sent by the chief medical director and medicines optimisation team of an ICB in England in response to webinars I delivered to hundreds of their prescribers.
Michelle Funk retweeted
Great to see our paper on how best to taper benzodiazepines and z-drugs finally in print (link below) in Psychological Medicine. It outlines the pharmacology of benzos and illustrates the hyperbolic nature of effects at all different scales. Some guidelines already recommend hyperbolic tapering and others still recommend linear. It would be worthwhile for all guideline committees to take into account the pharmacology of these agents when recommending tapering patterns. More research would also be very valuable but not a reason to stall (Stahl?) action on harm-minimisation tapering given how many suffer from severe and long lasting withdrawal effects from these drugs.
Michelle Funk retweeted
I wrote a brief blog about our new paper published criticising the FDA’s approval of escitalopram (Lexapro) for Generalised Anxiety Disorder in children and adolescents. The pivotal trial showed that the drug was more likely to make children suicidal than improve anxiety. The approval needs to be reversed urgently and the FDA approval process revamped. Link below
Michelle Funk retweeted
Very important to understand the following when you hear that the FDA has approved a new wonder drug for a mental health condition: “What many people and clinicians do not know is that the requirement of a “positive” trial does not mean that the drug is superior to placebo in a clinically meaningful way. Instead, the drug only has to be “statistically significantly” superior to placebo…Moreover, some drugs are approved despite there being more negative than positive trials.”
In this blog, Martin Ploderl explains how the makers of escitalopram exploited this loophole, getting FDA approval for the drug as a treatment for adolescent anxiety despite the fact that it is more likely to make young people suicidal than it is to make them less anxious.
madinamerica.com/2026/06/app…
Michelle Funk retweeted
Theo Von got personal on Joe Rogan’s podcast after revealing a sad story about his long-term struggle with antidepressants.
He told Rogan he was first put on antidepressants after “a tough day at school” and has NEVER been able to get off them since.
THEO: “That shit makes you feel dead, man.”
ROGAN: “So why did you take them in the first place?”
THEO: “Cause I was in a bad relationship 20 years ago, and I was having a tough day at school, and they f*cking gave them to me, and then I never got off.”
Theo’s experience is not uncommon.
A 2019 meta-analysis revealed that 56% of people experience withdrawal symptoms when trying to quit antidepressants.
Of those who experienced withdrawal symptoms, nearly half (46%) described them as “severe.”
Before you get placed on the antidepressant hamster wheel like Theo Von did, you should learn what these drugs really do.
The nasty withdrawal symptoms are just the tip of the iceberg of a much bigger problem... 🧵
Michelle Funk retweeted
Dana White’s transformation from October 2023 still felt wild when I watched it.
At that time he weighed 236 lbs, with triglycerides at 800, insulin in the 60s, blood pressure 160/110 on medication, constant leg pain and numbness, severe sleep apnea that woke him up choking and throwing up, almost no energy, and he kept falling asleep in meetings.
After working with Gary Brecka he dropped to 192–196 lbs, brought triglycerides down to 130, insulin to 9, blood pressure to 116/70 — and got off all his meds. He developed visible abs and said his workouts became off the charts. He told Rogan he felt like he was in his 20s again.
He quit drinking and followed the full Superhuman protocol.
What really stuck with me was when he said his doctors kept telling him everything was “fine” while he felt like death. They just kept adding more pills.
Dana was very open about his before-and-after numbers because he wanted people to know real change was possible when someone finally addressed the root causes instead of masking symptoms.
Anyone else inspired by how dramatically health and energy can shift when you finally get the right guidance?
Michelle Funk retweeted
"What we are calling a mental health crisis is in large part a crisis of overmedicalization. Taking complex and real human struggles rooted in nutrition, sleep... and purpose and reducing them to medical conditions in need of medical interventions."
Michelle Funk retweeted
Among adults with severe mental illness, integrating #PhysicalActivity into psychiatric care improves psychiatric symptoms, cognitive health, and cardiometabolic outcomes, supporting longer life expectancy.
ja.ma/4u6t7nG
Michelle Funk retweeted
As a Doctor, I Felt Compelled to Agree to ECT—It Nearly Ruined My Life
By Cathy Wield
Despite surviving, I’m utterly horrified by my experience of ECT.
madinamerica.com/2026/03/as-…
Michelle Funk retweeted
Surprise, surprise.
It turns out antidepressants may have been propped up by deeply flawed science.
“Most clinical drug trials have found the effectiveness of antidepressants is ON PAR with placebo,” wrote Dr. Joseph Mercola.
On the other hand:
“Large-scale meta-analyses show that physical exercise is the most effective remedy — about 1.5 times more effective than antidepressants — for depression.”
You probably never heard that on TV because in 1996, Bill Clinton signed the Telecommunications Act, which allowed Big Pharma to buy off the news.
Here’s what else they’re not telling you about antidepressants. If you or someone you love is taking them, you might want to read to this. 🧵
Michelle Funk retweeted
Sixty years ago, studies were done comparing antidepressants with what is called “active placebos,” drugs that mimic the side effects of antidepressants. The conclusion? Almost no difference in outcome.
Reading about the results of these 1960s studies was a lightbulb moment for British psychiatrist @joannamoncrieff. She was a junior psychiatrist at the time working in a mental hospital in the UK, and she started looking into these studies when she didn’t observe any obvious improvements in patients on antidepressants.
Larger and more developed trials conducted decades later likewise show such small differences between an antidepressant and a placebo that they do not qualify as a clinically meaningful difference, she says.
In 1998, psychologist Irving Kirsch published a widely publicized paper on this phenomenon called “The Emperor's New Drugs.”
Psychiatry, she says, hasn’t taken trial results seriously from many decades showing the ineffectiveness of antidepressants:
“Why has psychiatry… not said: ‘Oh dear, maybe we should stop giving out these drugs that are having minimal, if any, beneficial effects, and yet are causing side effects, making people dependent, giving people some really severe withdrawal problems, causing sexual dysfunction, making people have falls and bleeds, and causing fetal malformations and all the other things that antidepressants do.”
Michelle Funk retweeted
This is the part of the interview where I wonder why antidepressants are still recommended after decades-worth of research showing minimal, if any benefits and more and more evidence of harm
Sixty years ago, studies were done comparing antidepressants with what is called “active placebos,” drugs that mimic the side effects of antidepressants. The conclusion? Almost no difference in outcome.
Reading about the results of these 1960s studies was a lightbulb moment for British psychiatrist @joannamoncrieff. She was a junior psychiatrist at the time working in a mental hospital in the UK, and she started looking into these studies when she didn’t observe any obvious improvements in patients on antidepressants.
Larger and more developed trials conducted decades later likewise show such small differences between an antidepressant and a placebo that they do not qualify as a clinically meaningful difference, she says.
In 1998, psychologist Irving Kirsch published a widely publicized paper on this phenomenon called “The Emperor's New Drugs.”
Psychiatry, she says, hasn’t taken trial results seriously from many decades showing the ineffectiveness of antidepressants:
“Why has psychiatry… not said: ‘Oh dear, maybe we should stop giving out these drugs that are having minimal, if any, beneficial effects, and yet are causing side effects, making people dependent, giving people some really severe withdrawal problems, causing sexual dysfunction, making people have falls and bleeds, and causing fetal malformations and all the other things that antidepressants do.”
Michelle Funk retweeted
BBC's File on 4 covered finasteride's sexual and emotional side effects last week, including that they may persist and wreck lives. It raised the question of whether it should still be prescribed at all. We need coverage for similar SSRI effects bbc.co.uk/sounds/play/m002q2…
Michelle Funk retweeted
Staying on SSRIs long-term? Doctors often say it's safe, but after a decade of prescribing, I've seen 3 outcomes—only one being good. Tolerance and neurotoxicity are common. What's been your experience? #SSRI #MentalHealth
Michelle Funk retweeted
This is such a breakthrough in #cancer treatment by harnessing your own immune system to target tumors & potentially replace chemotherapy.
Dr. Patrick Soon-Shiong, founder of ImmunityBio & a prominent figure in oncology (recognized in 2025 as one of the 100 most influential people in the field), is advancing immunotherapy through the company's FDA approved drug “Anktiva”(nogapendekin alfa inbakicept-pmln), an IL-15 superagonist.
Approved in 2024 for BCG unresponsive non muscle invasive bladder cancer (NMIBC) with carcinoma in situ (with or without papillary tumors), Anktiva activates natural killer (NK) cells, T cells & memory T cells to target cancer cells more precisely than traditional treatments. This approach often results in fewer severe side effects compared to high dose chemotherapy, while promoting durable responses & potential long term protection against recurrence in approved indications.
Clinical trials & real world data show Anktiva reducing tumor burden in certain patients, with high complete response rates & prolonged disease free survival in bladder cancer. In 2025, notable progress included FDA Regenerative Medicine Advanced Therapy (RMAT) designation for Anktiva combined with CAR-NK therapy to reverse lymphopenia (immune suppression caused by chemotherapy/radiation) in advanced pancreatic cancer, along with expanded access authorization for lymphopenia treatment across solid tumors. Data presented at ASCO 2025 demonstrated significant overall survival benefits in late stage metastatic pancreatic cancer patients when lymphopenia was reversed & ongoing trials explore applications in lung cancer, glioblastoma & other tumors.
Anktiva represents part of the rapidly evolving field of immunotherapy, which has already transformed outcomes for many cancers. @DrPatrick vision emphasizes shifting toward immune activating therapies that protect & empower the body's natural defenses, potentially reducing reliance on toxic chemotherapy in select cases.
While promising, especially for #BladderCancer & emerging data in harder to treat cancers like pancreatic, more studies are ongoing to expand approvals & confirm broader efficacy & safety.
This work offers renewed hope for patients facing challenging diagnoses.
Michelle Funk retweeted
Instead of that psych drug, perhaps what you really needed was time off work, a person to care & listen, a quiet place to retreat, reflect, reassess & repair. Perhaps you needed us to treat you as worthy of a kinder world; of a social & human rather than a chemical response.
Michelle Funk retweeted
New research highlights a powerful link between #diet and long-term brain 🧠 health.
A study from the 1946 British Birth Cohort found that healthy dietary patterns are positively associated with cognitive reserve, the #brain’s ability to compensate for aging and disease.
Specifically, greater alignment with the Healthy Eating Index (HEI) and healthful plant-based diets was linked to higher #cognitive reserve in midlife, while unhealthful diets (high in items like sugary drinks 🥤 and refined grains) were linked to lower reserve. This suggests that what we eat over decades may help build #mental resilience.
The findings place diet alongside education and childhood cognition as a key factor in maintaining brain health. While childhood cognitive ability and adult #education level were the strongest predictors, healthy eating independently explained unique variation in cognitive reserve.
cdn.nutrition.org/action/sho…
