In this explosive and highly anticipated episode, Dr. Roger McFillin hosts Dr. Ragy Girgis, a Columbia University Professor of Psychiatry and researcher, for a no-holds-barred confrontation that exposes the shocking divisions tearing apart the mental health field. What begins as a conversation about mass violence research rapidly explodes into a devastating examination of psychiatric medicine's crumbling foundations, questionable effectiveness, and devastating potential harms. The two clash in fierce, unrelenting disagreements over fundamental issues including the validity of DSM diagnoses, the debunked "chemical imbalance" theory of depression, dangerous SSRI safety cover-ups and black box warnings, corrupted research quality and pharmaceutical industry manipulation, and the catastrophic crisis of psychiatric drug overprescription poisoning 1 in 4-5 Americans. Dr. Girgis desperately defends traditional academic psychiatry and current treatment approaches, while Dr. McFillin ruthlessly dismantles the entire paradigm, arguing that the current system is systematically creating chronic mental illness rather than healing it. Buckle up for this brutal intellectual warfare.
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Throughout the interview, Dr. Girgis repeatedly stated that "the data is clear" while dismissing contradictory evidence that challenges his conclusions. For our listeners' benefit, I have compiled research and documentation that directly disputes several of Dr. Girgis's key claims.

1. The serotonin theory of depression: a systematic umbrella review of the evidence (Moncrieff et al.)

Conclusions: "This review suggests that the huge research effort based on the serotonin hypothesis has NOT produced convincing evidence of a biochemical basis to depression. This is consistent with research on many other biological markers . We suggest it is time to acknowledge that the serotonin theory of depression is NOT empirically substantiated."
2.What has serotonin to do with depression?
Conclusions: "Simple biochemical theories that link low levels of serotonin with depressed mood are no longer tenable."
3. Is the chemical imbalance an ‘urban legend’? An exploration of the status of the serotonin theory of depression in the scientific literature

Violence & Suicide Associated with SSRI's
1. Precursors to suicidality and violence on antidepressants: systematic review of trials in adult healthy volunteers
2. Prescription Drugs Associated with Reports of Violence Towards Others

3. Antidepressant-induced akathisia-related homicides associated with diminishing mutations in metabolizing genes of the CYP450 family
4. Lexapro Approved for Pediatric Use Despite the 6-Fold Increase in Suicide Risk
5. McFillin Substack Review on Lexapro approved despite Suicide Risk
6. Suicidality and aggression during antidepressant treatment: systematic review and meta-analyses based on clinical study reports
7. Antidepressants Increase Suicide Attempts in Youth; No Preventative Effect
8. Effect of selective serotonin reuptake inhibitor treatment following diagnosis of depression on suicidal behaviour risk:
9.  FDA Warning: Antidepressants increase the risk of suicidal thinking and behavior (suicidality) in children and adolescents
10.  Suicide Mortality in the United States, 2001–2021 CDC documentation
11. US suicide rate reaches highest point in more than 80 years: See what latest data shows

12.  CNN article reporting Eli Lilly Internal Documents
"An internal document purportedly from Eli Lilly and Co. made public Monday appears to show that the drug maker had data more than 15 years ago showing that patients on its antidepressant Prozac were far more likely to attempt suicide and show hostility than were patients on other antidepressants and that the company attempted to minimize public awareness of the side effects. The 1988 document indicated that 3.7 percent of patients attempted suicide while on the blockbuster drug, a rate more than 12 times that cited for any of four other commonly used antidepressants.In addition, the paper said that 1.6 percent of patients reported incidents of hostility -- more than double the rate reported by patients on any of four other commonly used antidepressants."

Examples of Violence after Prescription in legal system (Sample)
January 24, 2020 – Newcastle, South Dublin, Ireland: Deirdre Morley, 44, smothered and killed her two sons Conor, 9, and Darragh, 7, and her three-year-old daughter Carla McGinley in their family home. She had been taking antidepressants since October 2018 and was admitted to St. Patrick’s Mental Health Services on July 6, 2019, but was discharged after a short period, but was put on a combination of two antidepressants and a sedative

May 11, 2018 – Osmington, Western Australia: Peter Miles, 61, shot his 35-year-old daughter and four grandchildren, aged 8 through 13, while they slept in their beds, in a shed that had been converted to a second house on the property. He then turned the gun on his 58-year-old wife in the living room of their house, before placing a call to police alerting them to his crimes. When they arrived, Miles was also found dead from a gunshot wound. Miles had started taking antidepressant medication just weeks before.

April 6, 2018 – Wadsworth, Ohio: Gavon Ramsay, 17, strangled his neighbor, 98-year-old Margaret Douglas in her own home. His parents blame his actions on his having been misprescribed Zoloft. After a report by his school principal that the teen was depressed and might harm himself, he “returned to therapy,” and after a recommendation by a psychologist, the family’s pediatrician prescribed the antidepressant Zoloft. From January through March leading up to the incident, the dosages were increased. During this time, his mother said she observed her son’s behavior change—becoming increasingly irritable and hostile and saying bizarre things.

October 21, 2013 – Sparks, Nevada: 12-year-old Jose Reyes opened fire at Sparks Middle School, killing a teacher and wounding two classmates before committing suicide. The investigation revealed that he had been seeing a psychotherapist 3 days before the shooting and was prescribed an antidepressant. He had a generic form of the antidepressant Prozac (fluoxetine) in his system at the time of death, police said

October 24, 2011 – Snohomish County, Washington: A unnamed 15-year-old girl went to Snohomish High School where police alleged that she stabbed a girl as many as 25 times just before the start of school, and then stabbed another girl who tried to help her injured friend. Prior to the attack, the girl had been taking “medication” and seeing a psychiatrist. Court documents said the girl was being treated for depression.

December 13, 2010 – Planoise, France: An unnamed 17-year-old youth held twenty preschool children and their teacher hostage with two swords for hours at Charles Fourier preschool. The teen was reported to be on “medication for depression.” Eventually, all the children and the teacher were released safely.

International Drug Regulatory Warnings

United States, November 10, 2021: The FDA updated the safety label for Effexor XR(venlafaxine) to include postmarketing reports of serious discontinuation symptoms including completed suicide, suicidal thoughts, aggression, and violent behaviorwhile reducing dosage or discontinuing the drug.

United States, November 10, 2021: The FDA updated the safety label for Pristiq(desvenlafaxine) to note that there have been postmarketing reports of serious discontinuation symptoms including completed suicide, suicidal thoughts, and aggression (including hostility, rage, and homicidal ideation) while reducing dosage or discontinuing the drug.

United States, November 13, 2020: The FDA updated the safety label for Trintellix(vortioxetine) to include aggression, agitation, anger, hostility, and irritability under Postmarketing Experience in the Adverse Reactions section.

Italy, May 18, 2017: The Italian Medicines Agency sent out a reminder to healthcare professionals about the use of antidepressants, particularly regarding risks in children and adolescents. The reminder warned against the use of Paxil (paroxetine) in those under 18, because of a lack of data on efficacy, in addition to the increased risk of suicidal and hostile behavior.

United States, May 4, 2017: The FDA updated the safety label of Zyban (bupropion) to that while Zyban is not indicated for depression, it has the same active ingredient as antidepressants Wellbutrin, Wellbutrin SR, and Wellbutrin XL. Antidepressants increase the risk of suicidal thoughts and behavior in children, adolescents, and young adults in short-term drug trials. Neuropsychiatric adverse events (e.g., mania, depression, psychosis, hallucinations, paranoia, delusions, homicidal ideation, hostility, agitation, anxiety, panic, suicidal ideation, suicide attempt, and completed suicide) have occurred in those with and without pre-existing mental illness. Some patients experienced worsening mental illness. In a clinical trial of patients with or without a history of mental illness, the adverse events reported in over 10% of subjects taking Zyban were nausea, insomnia, and anxiety.

United States, May 4, 2017: The FDA updated the safety labels of Wellbutrin and Wellbutrin SR(bupropion) to include aggression, hostility, panic, suicidal ideation, suicide attempt, and completed suicide as reported in post-market reports for bupropion as a smoking cessation treatment. Neuropsychiatric adverse events (e.g., mania, depression, psychosis, hallucinations, paranoia, delusions, homicidal ideation, agitation, and anxiety) have occurred in those with and without pre-existing mental illness. Some patients experienced worsening mental illness.

United States, December 23, 2016: The FDA updated the safety label for Zoloft(sertraline) to include a warning for suicidal thoughts or actions in patients aged 24 and younger. Pediatric patients are to be monitored for suicidal thoughts, clinical worsening, or unusual behavior, especially when starting the drug or changing the dosage. Patients and their caregivers are advised to look for the emergence of mania/hypomania.

United States, February 2013: The FDA added the following side effects updates to the “Adverse Reactions” in Pristiq’s (desvenlafaxine) drug label which included Suicidal Thoughts and Behaviors in Adolescents and Young Adults and Activation of Mania/Hypomania.

Japan, May 2009: The Japanese Ministry of Health, Labor and Welfare investigated news reports of antidepressant users “who developed increased feelings of hostility or anxiety, and have even committed sudden acts of violence against others.” After its investigation, the Ministry decided to revise the label warnings on newer antidepressants stating, “There are cases where we cannot rule out a causal relationship [of hostility, anxiety, and sudden acts of violence] with the medication.”

United States, November 2005: The FDA’s Safety Information and Adverse Event Reporting Program reported safety label changes for Effexor XR (extended-release). This included the following Adverse Reactions: adverse events associated with discontinuation of treatment, panic disorder, and homicidal ideation.

European Union, August 19, 2005: The Commission of the European Communities, representing 25 European countries, endorsed and issued the strongest warning yet against child antidepressant use as recommended by Europe’s Committee for Medicinal Products for Human Use (CHMP). Clinical trials had shown that the drugs caused suicidal behavior including suicide attempts and suicidal ideation, hostility(predominantly aggression, oppositional behavior, and anger), and/or related behavior.

Australia, December 2004:The Australian Adverse Drug Reactions Advisory Committee reviewed data on the safety and efficacy of using SSRI antidepressants in children for the treatment of depression. Their assessment of published and unpublished data available for SSRI use in children and adolescents indicated that there is evidence of an increased risk of suicidality, including suicidal ideation, suicide attempts, and self-harm events, associated with each of the SSRIs. Further, in a recent study involving fluoxetine (Prozac), there was an increase in some adverse psychiatric events (acts and ideation of suicide, self-harm, aggression and violence).

United Kingdom, September 21, 2004: The British Healthcare Products Regulatory Authority advised that it had issued guidelines that children should not be given most SSRI antidepressants because of clinical trial data showing an increased rate of harmful outcomes, including hostility.

Canada, June 03, 2004:Health Canada issued an advisory to the public stating that stronger warnings have been placed on antidepressants. These warnings indicate that people taking these drugs at any age are at greater risk of behavioral or emotional changes including self-harm or harm to others. The advisory said, “[A] small number of patients taking drugs of this type may feel worse instead of better…. For example, they may experience unusual feelings of agitation, hostility or anxiety, or have impulsive or disturbing thoughts that could involve self-harm or harm to others.”

United States, March 22, 2004:The FDA asked drug companies to add new warnings on 10 widely used antidepressants. It said patients given these drugs should be closely monitored for worsening depression or suicidality, especially when the patient first begins taking the drugs or changes doses. At the time the FDA had not concluded whether the worsening of symptoms was due to the underlying disorder or the drug. It also said, “Anxiety, agitation, panic attacks, insomnia, irritability, hostility, impulsivity, akathisia [severe restlessness], hypomania [abnormal excitement, mild mania] and mania, have been reported in adult and pediatric patients being treated with antidepressants….”

Canada, August 22, 2003:Health Canada posted a letter sent out to healthcare professionals about updates to Effexor’s prescribing information. The letter explained that in clinical studies in pediatric patients (aged 6 to 17), efficacy was not established for major depressive disorder or generalized anxiety disorder. Also, there were increased reports among those patients on Effexor XR (vs. placebo) of hostility and suicide-related adverse events, such as suicidal ideation and self-harm.

Psychiatric Diagnoses (DSM) Lack Validity and Reliability
1. The Reliability of Psychiatric Diagnoses
2. Director of top research organization for mental health criticizes DSM for lack of validity
3. No more psychiatric labels: Why formal psychiatric diagnostic systems should be abolished
4. Psychiatric diagnosis 'scientifically meaningless'
5. The Myth of the Reliability of DSM
6. Why DSM is mostly false
7.  Psychiatric Diagnostic Uncertainty: Challenges to Patient-Centered Care
8. Poor Separation of Clinical Symptom Profiles by DSM-5 Disorder Criteria

Burden of Mental Illness on the Rise
1. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019
2. National Trends in Mental Health Disability, 1997–2009
3. Changing trends in the global burden of mental disorders from 1990 to 2019 and predicted levels in 25 years

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