Persistent unexplained physical symptoms: a prospective longitudinal cohort study in UK primary care

Doctors, psychiatrists, psychologists and therapists are clearly being actively trained to believe that their patients are ‘somatising’ (experiencing psychological distress in the form of somatic - physical - symptoms and seeking medical help for these symptoms, which may be initiated and/or perpetuated by emotional responses such as anxiety and depression).

In fact, many are actually suffering the serious physical effects of commonly prescribed ‘safe and effective’ (sic) ‘antidepressant’ medicines, which (effects) are therefore remaining dangerously unrecognised by prescribers – with serious consequences.

Antidepressant withdrawal/discontinuation symptoms were recognised in the 1990s by researchers using the DESS (Discontinuation-emergent signs and symptoms) scale.¹ In the early 2000s this list of very debilitating symptoms was divided up and re-branded (with funding from Pfizer) to become questionnaire screeners for Depression PHQ-9, Anxiety GAD-7, and ‘Medically Unexplained’ ‘Somatic symptoms’ PHQ-15.² These screeners have been widely adopted for general and online use. Busy GPs have been led and trained (even incentivised) to believe that their patients ‘need’ antidepressants, per PHQ-9 and GAD-7 scores³ and that their patients’ subsequent development of multi-system effects/symptoms and suffering is just ‘psychosomatic’ (PHQ-15). The actual suffering experienced could more accurately be described as severe homeostatic disruption caused by the prescribed drugs - and can wreck people’s physical health, sense of self, self-esteem, work, social lives and relationships.

Doctors are led to believe that their patients are suffering ‘medically unexplained’ somatic/functional symptoms (filed under DSM ‘psychiatric’ disorders), ‘of unknown aetiology’ such as ‘chronic fatigue’, IBS, fibromyalgia, etc. The patients’ earlier diagnosis of ‘depression/anxiety’ is used to validate the ‘psychosomatic’ label,⁴ therefore leading to the conclusion that CBT and graded exercise provides suitable treatment to correct their patients' fictitious illness beliefs.

This is the biopsychosocial model being turned in its head – with truly devastating health and life consequences, not least the breakdown of trust in the doctor/patient relationship. We are unwittingly caught up in this. The British Journal of General Practice published my recent e-Letter responding to the April edition themed around ‘medically unexplained symptoms’.⁵  More in my podcast for Human Givens Institute 'Why antidepressants need to be understood'.⁶ 

References
1. (SSRI) Discontinuation-Emergent Signs and Symptoms (DESS) scale. https://hulpgids.nl/assets/files/pdf/DESS.pdf. 
2.  PHQ (Patient Health Questionnaire) Screeners. https://en.wikipedia.org/wiki/Patient_Health_Questionnaire.  
3.  Davies, J. The Sedated Society – The real story of our Prescribing Epidemic. Mad in America 2017. www.madinamerica.com/2017/02/sedated-society-prescribing-epidemic. 
4.  Harvey, S.B. and Wessely, S. Chronic Fatigue Syndrome. BMC Medicine 2009; 7:58. https://bmcmedicine.biomedcentral.com/articles/10.1186/1741-7015-7-58. 
5.  Brown, M. Response to Editor’s briefing BJGP April 2019. The right stuff – or the wrong stuff? https://bjgp.org/content/69/681/163/tab-e-letters#the-right-stuff---or-t... 
6.  Human Givens Institute 'Ask the Expert' Podcast 3. Why Antidepressants need to be understood. 2019 www.hgi.org.uk/resources/podcasts/why-antidepressants-need-be-understood.