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on 19 March 2014
This is a thorough and thoughtful book which presents a careful analysis and criticism of psychiatric prescribing and the influence of the drug industry.

That said, I'm not sure that what she says here adds significantly to information given elsewhere. If you've read, for example, Richard Bentall's books (Doctoring the MInd and Madness explained) plus her excellent "Straight-talking Introduction to Psychiatric Drugs" this book will not add a great deal.

It also leaves the patient and their family wondering what to do about this situation. We have this knowledge, yes, but how can it help us and what can we do instead? At the end of the book I'm armed with information on what NOT to do plus perhaps some ideas for more searching questions for mental health practitioners. I needed to know what to do instead of relying on antipsychotics.
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on 21 October 2013
In this book, Dr Moncrieff explains carefully, soberly and with considerable academic integrity, how the world of psychiatry has become distorted by its own desire for recognition as a medical profession, its dubious assumptions about the nature of mental conditions and by the efforts made by drugs companies to increase their business.

Dr Moncrieff explains how the desire for psychiatry to be as scientific/medical as other areas of health has led to rushed conclusions about the link between brain chemistry/biology and complex mental conditions of the mind such as schizophrenia, manic depression and anxiety.

The assumption made is that a chemical imbalance in the brain requires toxic 'antipsychotic' drugs to counter it, and like insulin for diabetes, over a lifetime since it is a permanent deficiency in the brain. This assumption is shown to have little or no evidence to support it, yet is the mainstay of modern psychiatric practice. Dr Moncrieff proposes an alternative view, that the drugs are simply suppressing brain activity, and thus appear to 'cure' mental conditions. The trouble is, whichever view is taken, the drugs have toxic effects which are in many ways no different those from the illegal drugs taken for pleasure that we criminalise in society. These effects are downplayed as 'side effects' despite there being substantial evidence of long term damage to body and brain health.

Dr Moncrieff shows how drugs companies, keen to maintain and improve their business, have funded research which shows marginal and questionable improvement through their drugs and have suppressed negative reports. Despite contradictory results, this 'research' is followed by advertising and efforts to shift the wider society understanding of mental health, so that patients demand ever more drugs to 'cure' their sometimes modest problems, now made to sound like serious illnesses.

The distortions to academic practice, pyschiatric prescription and most damning of all, the attempts to treat young children with toxic drugs are revealed by Dr Moncrieff with careful attention to the published record in a convincing manner, providing a solid basis for further debate.

But, most damning of all, is the experience that Dr Moncrieff reports of a refusal in the psychiatric world to engage with these issues or to properly discuss the ethical dilemmas that arise. I found myself intrigued, challenged but ultimately enraged by the failure of the academic/medical professionals to 'do no harm'.

I recommend this book without reservation to anyone prepared to think hard about these issues, and who perhaps has been unaware of concerns about mental health treatment and the huge cost to the well-being of society. It is then for us to take up the challenges Dr Moncrieff has described and ask how are we and society to respond?
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on 11 October 2013
This book is an important book about antipsychotic drugs. It describes the history, effects, side effects, costs and benefits of this medication. "Antipsychotic" drugs, also known as major tranquillisers are increasingly popular, prescribed not just by psychiatrists, but GPs and hospital doctors to a wide range of people, whose behaviour is causing difficulties either for themselves or those charged with looking after them.

Dr Moncrieff is a world expert and researcher in this field, and neuroscientist from University College, London University and psychiatrist.

Antipsychotic medications (the bitter pills) are not a cure, nor even disease modifying drugs for major mental illnesses. Rather than modify the "disease process" of schizophrenia, bipolar disorder, depression as well as anxiety, insomnia and challenging behaviours, they have their effect by suppressing the symptoms of psychiatric illness.

This book describes the effects and side effects of this common group of medications. The purpose of the book is stop people sleep walking into somnolence and drug induced stupor. Whatever a psychiatrist might say about the benefits of antipsychotic medication, they need to weigh those benefits against the long term complications of medicating people. These complications include neurological (brain and nerve) as well as physical illnesses, from tardive dyskinesias (abnormal movements) and deteriorating mental health, apathy, inertia, cognitive impairment to obesity, heart disease and diabetes.

The book is well written, although perhaps more academic than some people would choose. There is an excellent glossary and for those who prefer a more gentle introduction, the last two or three chapters stand alone :
The Early Intervention Movement
The Antipsychotic epidemic: Prescribing in the twenty first century
All is not as it seems

This book has given me hard evidence to support my view that we must find better and less destructive ways to manage mental health and wellbeing than "popping a pill" and swallowing hard. As I tell anyone who listens, "taking psychiatric drugs for mental distress, is like pouring battery acid on your laptop. And doing so in the knowledge that there are very few repair shops and that your one and only laptop cannot be replaced this side of the hereafter". Our brains are too precious to be treated in this way. The effects of antipsychotics are worse than I thought and the evidence supporting them, is thinner than anyone might believe possible.

This book is not a light read, but these are serious drugs. This book should be compulsory reading for all doctors who have ever prescribed these drugs, and should be included with all prescriptions for them. The author does not suggest that there is not a place for anti psychotic medication, especially when a person is seriously distressed. However she does suggest that we need to look carefully at the long term effects of a class of drugs that significantly bolsters the profits of the pharmaceutical industry, and where there is little convincing evidence of long term benefits.

This is a brave book and should cause controversy within the profession. However doctors, especially psychiatrists, have a habit of skirting round evidence they don't like or that challenges their existing practices. Patients, relatives and friends, do not have the same lack of insight. I heartily recommend it, especially the last three chapters.

Dr Liz Miller author Mood Mapping: Plot your way to emotional health and happiness
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on 5 November 2013
Well-written and thoroughly researched, this book tells the bizarre tale of how mainstream psychiatry persauded itself it had discovered specific treatments for schizophrenia and psychosis, but it could only do this by ignoring the fact that these drugs are highly toxic.

Psychiatrists are so desparate to believe that antipsychotics are safe and effective they ignore or discount the evidence to the contrary. 'The Bitterest Pills' is above all a book of evidence. There is no research evidence that antipsychotics improve the outcome in the long-term and plenty of evidence that suggests they make it worse.

I know this is hard to believe. Would all those clever doctors mislead us all? Don't take my word for it: read this book and make up your own mind.

In Dr Moncrief's own words: "It is important to state straight away that I am a practicing psychiatrist, and that I believe that antipsychotics have a role in helping to suppress the manifestations of severe mental disturbance. I have seen people who are locked into an overwhelming psychotic state, which can sometimes be sufficiently suppressed by antipsychotics of one sort or another that they are able to regain some contact with the outside world again. This suppression comes at a price, however, as other thoughts and emotions are also slowed and numbed, but for some people this price is worth paying, at least initially. The cost-benefit analysis of long-term treatment, especially in people who have recovered from their acute episode, is more difficult to fathom... I hope this book will enable readers to re-evaluate the story of antipsychotic drugs as it is usually told, and appreciate the many dangers they represent, as well as the opportunities they provide some people in the grips of a severe mental disorder. It is intended to throw a sceptical light on the acres of research literature and marketing material that present these drugs as a practically untarnished boon to humankind, but also to show, through first-hand accounts, how the drugs might be distinctively helpful in some situations. It should also raise questions about the consequences of long-term treatment, and why, six decades after their introduction, we still cannot be sure if antipsychotics help or harm people who take them for long periods of time."
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on 5 November 2013
Great book. Really pushes the fact that no real proper research has been carried out on mental health in years. I admire the courage of the author. In our National Community Mental Hospitals are being closed just as they were 40 years ago.
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on 23 July 2015
As a carer for someone with depression with psychotic symptoms, i saw first hand that low doses of antipsychotic can bring on parkinsonism. I am spreading the word, that Peter C Gotzsche said in his book, Deadly Medicines and Organised Crime, antipsychotics should be used sparingly if at all, are dangerous and cause severe and permanent brain damage.The side affects can be horrendous. Thank God researchers are now looking at the Gut-Brain connection in relation to mental illness.
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on 7 February 2016
If Joanna Moncrieff is no more than half correct in her suggestion that antipsychotics are not treating an underlying brain disease then psychiatry still lies in ruins. one of a number of important recent books questioning the whole basis of the mental illness industry. should be read by anyone who works in it or is likely to be on the receiving end of its efforts to help
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on 14 October 2013
I have recommended this book to some of my friends because it explains how Psychiatry and Pharmaceuticals have worked together for decades - for better or worse. It has changed my life. I was impressed with De-medicalizing Misery, but had to wait for this book to be published to trust my own perceptions.

I begin to wonder if my mother's initial Alzheimer's diagnosis took into account her anxiety medication or the post traumatic stress of WW2. She also took corticosteroids for asthma (anxiety induced or possibly as a result of working in the textile industry in the 1950s and 1960s and calcium medication for osteoporosis).

The meds suit some people but not others - I think psychiatrists sometimes view patients as collateral damage.
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on 15 May 2014
This book should be on the curriculum of every medical school. Every general practitioner and psychiatrist should read it. So much damage is caused by antipsychotic medication and by doctors' ignorance.
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on 13 July 2014
Informative and very extensively researched exposition of this area.Helpful to have some idea how these drugs actually work and the issues and context surrounding them.
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