Ray Peat was a confusing sort of guy… he wrote about his ideas in “books” and articles. You literally have to navigate to a “website” to read some of his stuff. He often wrote words, arranged left-to-right in what are called “paragraphs.” Hard guy to pin down.

The path to greatness cuts right through the garden of scaring the hoes

“So don’t prescribe them for minor issues.” Okay. And how do we go about making that change? By talking about iatrogenic harm from overprescribing. Which is what we’re doing. Here’s the thing, though: “strong efficacy in real-world studies” is a joke. And adding the qualifier “moderate to severe” doesn’t save you either. In a real-world cohort of 673,177 UK patients, mostly prescribed SSRIs, average depression severity fell from moderately severe to moderate after two months. Authors described effectiveness as “small-to-moderate.” Most of the 116,000+ adult participants in Cipriani’s 522-trial antidepressant analysis already fit the “moderate to severe” description. Average advantage over placebo was 0.3 standard deviations. I’m not seeing “strong efficacy.” For childhood depression, Cochrane found Prozac’s average advantage over placebo was 2.84 CDRS-R points: “small and unimportant.” That’s <3 points on a 96-point range, by the way. Irving Kirsch has spent decades studying placebo effects. His analysis of four antidepressants found an average advantage of just 1.8 HAM-D points over placebo. 52-point scale. That’s pitiful. In the most severely depressed samples, it reached just over 4—but because placebo improvement fell, not because drug improvement increased. Important distinction. Patients familiar with antidepressant side effects could recognize their absence, realize they were getting placebo, and would then lose confidence in the treatment. Want me to keep going? I can keep going. You can’t point to the danger of depression and count that as proof your drugs prevent suicide. Treatment-induced suicidal behavior has to enter the calculation too. In 2000, psychiatrist David Healy estimated that Prozac had already caused approximately 50,000 excess suicides. You can challenge his estimate, but spare me the claim that this concern comes from “people who never studied pharmacology.” It’s a long list of MDs and PhDs. It’s internationally recognized psychiatrists and researchers with decades of clinical and academic experience. Prozac’s own prescribing information says the adult trials recorded too few suicides to determine the drugs’ effect on suicide deaths. It also warns of increased suicidal thoughts and behavior in younger patients. We criticize SSRIs because of the scale. And because their efficacy is oversold (by people like you!). And because they hurt people. Sometimes for many years after cessation. Other psych drugs are prescribed less often, but not less overprescribed. We criticize psychiatry as a whole. No other profession hands out drugs with such poor track records and gaslights their maimed patients afterwards. You agree they shouldn’t be prescribed for minor issues. Then engage with the overprescribing argument instead of dismissing the people making it.

One shitty Iranian trial of 40 kids inflated Prozac’s benefit in two major meta-analyses. Remove the trial and the benefit halves. Think of this the next time your doctor condescends to you about “the Science.” This is the science. Cochrane’s 2021 review found Prozac offered just 2.84 CDRS-R points over placebo (96-point range): “small and unimportant.” Kirsch’s adult analysis found 1.8 HAM-D points over placebo. That’s 40% below the NICE benchmark for a clinically meaningful benefit. These are the numbers behind all that hubris. SSRIs are whole-body drugs whose full effects we still don’t understand. Even Prozac’s label admits its exact mechanism is unknown. And no, it’s not correcting a serotonin deficiency. That’s marketing. Lilly’s own correspondence reveals instructions to code suicide attempts as “overdoses” and suicidal thoughts as “depression.” Courts have found antidepressants responsible for egregious homicides and murder-suicides, even at normal prescribed doses. Severe sexual side effects can persist for decades after stopping these drugs. For some people, getting off means years of careful hyperbolic tapering, down to fractions of a milligram. And we’re giving these drugs to children like they’re Tylenol. This has to stop.

This Men’s Health article written by Gregory Scott Brown, MD (@GregorySBrownMD), is a good example of why people have stopped trusting psychiatrists. And why nobody alive today actually reads Men’s Health (US circulation has fallen 75% since 2009 and UK circulation by 66% since 2010). The overconfidence here is extraordinary. Almost every single point made falls apart under scrutiny. Let’s debunk the claims and remind Greg why there’s a “war” on antidepressants. CLAIM #1: “In other cases, anxiety or depression may have come back when they tried to stop antidepressants in the past. This means the drug was working the way it was supposed to.” Psychiatry loves this trick. And it’s really not even appropriate to call it a trick because I’m positive these people don’t know better. The industry is deceptive; the prescribers are simply clueless. But I digress. You cannot conclude the drug was necessary without first ruling out withdrawal. When you take an SSRI/SNRI, you are taking a drug that chemically alters your brain in ways not comparable to taking a Tylenol. What I mean is: when you stop taking the drug, you don’t just snap back to baseline like a rubber band. Your nervous system adapts to the presence of the drug and stopping it does not guarantee an immediate return to how you felt before treatment. The drug can leave your system before your nervous system has readjusted. That can produce withdrawal symptoms, including symptoms you never had before taking the drug. Withdrawal symptoms can persist for months or years. Sexual dysfunction can also persist after stopping, a separate adverse effect now (finally) acknowledged by regulators. Psychiatry has no answer for this. Most clinicians hardly even acknowledge it. Withdrawal can cause anxiety, depressed mood, insomnia and suicidal thoughts. Restarting the medication can relieve those symptoms. That doesn’t prove any original illness returned, or that underlying illness was discovered. If your psychiatrist fails to recognize withdrawal, you can end up back on the drug indefinitely, or with another prescription added to treat symptoms caused by coming off the first one. The Maudsley Deprescribing Guidelines explicitly warns about this, including the consequences: unnecessary long-term prescribing and patients coming to believe they have a severe illness that requires indefinite medication. If you mistake withdrawal for relapse, you can spend years treating a problem the medication helped create while congratulating yourself for treating the underlying condition (Maudsley, pp. 107–109; see also RCPsych guidance). CLAIM #2: “If you stop Paxil cold turkey, you might feel a little ‘off,’ more irritable, or like you have a mild version of the flu for a couple of days.” This is straight-up false. Paroxetine (Paxil) is among the antidepressants with the highest withdrawal risk. The Royal College of Psychiatrists lists possible withdrawal symptoms including intense anxiety, electric-shock sensations, dizziness severe enough to prevent standing unaided, akathisia and suicidal thoughts. Symptoms can last months or more than a year. Imagine developing those symptoms after being prepared for a couple of mildly unpleasant days. And then imagine being told the distress proves you needed the drug. These two mistakes can reinforce each other. CLAIM #3: “One study published in The Lancet Psychiatry showed that about 15 percent of patients experience withdrawal symptoms such as insomnia and headache when stopping their antidepressant.” The cited review actually found symptoms in approximately 31% of people stopping antidepressants and 17% stopping placebo. The 15% estimate was what the authors attributed to antidepressant withdrawal after accounting for background symptoms. It also estimated severe symptoms in 2.8% of people stopping antidepressants. Even that estimate means roughly one in 35 (Henssler et al., 2024). Moncrieff et al. (Psychological Medicine, 2025) identified serious limitations: short treatment periods, short follow-up, reliance on patients spontaneously reporting symptoms, and possible misclassification of withdrawal as relapse. How confidently can you reassure someone who has taken a drug for ten years using studies that often involved brief treatment and brief observation after stopping? Most adult SSRI trials last about eight weeks, and almost none are longer than a few months. CLAIM #4: “SSRIs may help you feel calmer by allowing the brain to utilize the chemical serotonin more efficiently.” This is indefensible and the author should be embarrassed to say this in 2026. SSRIs inhibit serotonin reuptake. That’s one thing that this class of drug does, and it’s separate from the claim Gregory is making. Even Lilly’s own Prozac prescribing information acknowledges that its exact mechanism is unknown: “Although the exact mechanism of FLUOXETINE is unknown, it is presumed to be linked to its inhibition of CNS neuronal uptake of serotonin.” (Prozac prescribing information, § 12.1) Irving Kirsch addresses this inference in The Emperor’s New Drugs: observing what a drug does to neurotransmitters does not establish what caused the illness. It’s like saying a headache is an aspirin deficiency. CLAIM #5: “But that’s because they have been studied, have been proven to work, and most people don’t have severe side effects from them.” Then tell readers how much benefit the drug adds. Kirsch’s 2008 analysis of published and unpublished FDA trials found average improvement of 9.6 Hamilton depression points with medication and 7.8 with placebo. The additional average benefit was 1.8 points. On a 52-point scale. That was below the three-point threshold for clinical importance used in the analysis. The difference was extremely modest. You cannot credit the medication with every improvement that happens while someone takes it. If a painkiller beat a sugar pill by 1.8 points on a 52-point scale, under the bar for clinical importance (Kirsch et al., 2008), and could leave you with severe, prolonged adverse effects, you wouldn’t buy it. You can’t sell SSRIs without lying to the buyer. CLAIM #6: “Since the first antidepressants were approved in the 1950s, and SSRIs in the late 1980s, antidepressants are estimated to have saved tens of thousands of lives.” Where does that number come from? The FDA’s analysis of 372 adult trials recorded only eight suicide deaths. The authors explicitly said their study could do little to resolve whether antidepressants affected death by suicide. Adults under 25 given antidepressants for psychiatric conditions had more than twice the odds of suicidal behaviour as those given placebo (OR 2.30) (Stone et al., 2009). And the suicide concerns predate Prozac’s US approval. In 2000, the Boston Globe reported that German regulators had initially refused to approve it after Lilly’s studies showed a combined rate of suicides and suicide attempts three times that on placebo and five times that on older antidepressants (Garnett, 2000). Lilly’s own correspondence shows reported suicide attempts being coded as “overdoses” and suicidal thoughts as “depression.” In Let Them Eat Prozac, David Healy reproduces a German Lilly executive’s objection to those instructions: he could not justify them to the regulator, a judge, a reporter or even his own family. Peter Gøtzsche examines related reporting failures in Deadly Medicines and Organised Crime. If you’re going to put a number on lives saved, show the calculation. And account for iatrogenic harms, too. You can’t establish a mortality benefit by pointing to modestly improved depression scores. CLAIM #7: “Psychiatrists are pretty good at helping patients taper antidepressants in a way that is comfortable and safe.” This could not be further from the truth. For thirty years, Maudsley, one of the major names in psychiatry, published guidelines telling doctors which drugs to prescribe and how. In 2024, it finally published an entire book on getting people off them safely. Its authors describe patients turning to online communities because their prescribers failed to recognise withdrawal or recommended dangerously fast tapers. The people who write the prescribing manuals are now confronting the harm caused when doctors don’t know how to stop what they started. In other words: The entire reason the book exists is because psychiatrists and GPs don’t handle tapering well. Psychiatrists don’t understand their treatments nor the adverse effects. Their hubris and gaslighting are causing direct harm to their patients. And they’re failing to see it, routinely. Many people want to stop these drugs and need competent help doing so. How is anyone supposed to make an informed decision when withdrawal is understated, its symptoms can be mistaken for illness, and that mistake can become the justification for keeping them medicated? @GregorySBrownMD, do you expect your patients to trust you? Why should they?

Recreational drugs and psychiatric drugs get compared as if both were just “substances that change the brain.” Bad comparison. A recreational drug’s high is usually an episode. The state arrives, it’s obviously not baseline, and it ends in minutes or hours. If you misjudged it, you wait it out. The person who took the drug is still there to compare notes with the person coming down. Many psychiatric drugs are not like this. They are a new climate. Some reactions are acute and obvious. Others are slow: less urgency, less wanting, less range, less sex, less edge. Piece by piece. Little by little. You replace a plank here and there and the result is still technically you. You are the Ship of Theseus. Not only have the parts changed, but the observer of the changes has changed alongside them. Friends may notice first. The clinic may call it improvement. Stopping is not the same as “sobering up,” because there may be no clean “after” and the person who would have wanted off may no longer be the one deciding. You can consent to a pill. You can’t fully consent in advance to the self who might later prefer the pill. Or decide that more of it is a good idea.