News

Examining the Long-Term Impacts of Psychotropic Drugs and Considerations for People Discontinuing Treatment 

28 April 2025

Psychotropic drugs dominate the mental healthcare landscape. This is despite contention over their

proposed mechanism of action, concerns for their adverse effects, and questionable effectiveness,

especially over the long term. Mental health nurses are routinely involved in administering

psychotropic drugs, observing for and managing adverse effects, and providing information and

support to people prescribed these agents. This critique published in March 2025 explores the current understanding of the

mechanism of action for psychotropic drugs, evidence for their effectiveness, adverse effect burden

and implications for long term use. The role of mental health nurses in de-prescribing and supporting

people to discontinue treatment is also considered.

Is ADHD for life?

18 April 2025

On a Substack blog post Giselle Bahr reviews two Aotearoa New Zealand studies and one USA study whose results challenge the belief that ADHD is a life-long disorder. 

ADHD or still growing?

25 March 2025

On a Substack blog post Giselle Bahr explores evidence that youngest children are diagnosed more often with ADHD.

Is ADHD diagnosis harmful?

3 March 2025

On a Substack blog post Giselle Bahr reviews two studies that suggest providing an ADHD diagnosis may be harmful to some.

What We Call Mental Disorders Aren't 

8 October 2024

Over our lifetimes, more than 80% of us will experience a mental health disorder.

And yet most people believe that psychiatric disorders are abnormal, affecting only a

few people at the far edge of the spectrum of human behaviour. So, if most of us

receive a diagnosis of mental disorder at some point, should we still call these

experiences “abnormal" or even “disorders”? Is our current medical model fit for

purpose? 

In a new Danish analysis of medical records from a random sample of 1.5 million

people, researchers combined data about people who had received a mental health

diagnosis from a hospital service with data about people prescribed psychiatric

medications. Their surprising conclusion is that 83% of Danish people experience a

mental health disorder. That is, a mere 17% make it through life without one. And

even though the figure of 83% seems high, it’s probably an underestimate because

the study didn’t include people with undiagnosed (but existing) mental disorders.

Not every distressed person is seen by health services. 

In Aotearoa, we see similar results in our very own Dunedin Multidisciplinary Study.

A 2020 analysis found that 86% of the Dunedin participants had experienced at least

one mental health disorder by the age of 45. That figure is higher than the Danish

study that spanned people’s whole lives. So why did New Zealanders eclipse the

Danish lifetime rates at such a young age?

The Dunedin Study includes every child born in Dunedin from April 1972 to March

1973. Nine interviews, including full psychological assessments, were completed with

the Dunedin participants by the age of 45. The 2020 Dunedin analysis counted all

diagnoses over each life, including diagnoses for people who hadn’t sought help from

the health system. The Danish study, on the other hand, relied on medical and

prescription records only.

To judge from the Danish study, we will probably see even higher lifetime rates of

mental disorder among the Dunedin participants as they grow older - psychological

distress in both countries appears to be almost universal. These findings challenge

the widespread view that people fall into two groups: those with mental disorders

and those without. They raise questions about our current understanding of

normalcy and mental illness. And they require us to reconsider our current responses

to psychological distress.

The medical model shapes how we now think about mental illness. The model

assumes that mental disorders are diseases of the brain, and it uses neurobiology to

explain mental conditions and justify interventions. Advocates of the medical model

propose pharmacological solutions, because they believe that psychopathology

stems from problems in neuro-anatomy, or brain activity, or neurotransmitters, or

genetics, or the endocrine system. But the Danish and Dunedin studies suggest

almost everyone suffers from mental health disorders at some point. And the

medical model’s search for specific physical abnormalities cannot explain this nearly

universal experience.

Alternative models for understanding psychological distress already exist. In

Aotearoa we have the long-established Te Whare Tapa Wha and the more recent

Meihana Model. The UK’s Power Threat Meaning Framework and the US’s Process

Based Therapy also provide different views. Rather than labelling a separate group of

people mentally ill, practitioners of these models map out the interacting factors that

cause people’s distress. These approaches assume that everyone struggles to

survive, to form relationships, to find a place in the social group and to secure

resources. In other words, emotional distress and troubled or troubling behaviour

represent responses to a person's history and circumstances. And so we would

understand those behaviours best by understanding people’s  cultures and contexts.

Psychological distress is real, and experienced throughout our entire community.

Advocates of the medical model locate its causes and solutions within individual

people’s biology. But if mental distress is indeed a response to difficult human

experiences, its causes and helpful solutions may be found in communities. 

People’s mental health thrives when their basic needs are met, their community

shares its resources fairly, and people are free from prejudice and violence. Family,

friends, economic circumstances, education and environment all contribute to our

wellbeing. We need to build communities that support each of us when we

experience psychological distress. As the UN Special Rapporteur noted, “Everyone,

throughout their lifetime, requires an environment that supports their mental health

and wellbeing ... we are all potential users of mental health services”.  

We already know many solutions. Countries with better income equality have lower

rates of mental illnesses. We feel less depressed and worthless when nearby vacant

land is tidied and planted. We do better when we eat fresh fruit and vegetables.

Moving our bodies reduces depression and anxiety. Most importantly, as social

creatures, we need support from others in tough times. Sometimes we’ll be the

people needing support, and sometimes we will be giving it. 

It’s increasingly clear that psychological distress will affect almost all of us. This

universality doesn’t fit well with a medical model that diagnoses and treats human

abnormality. We need to develop a new language for these experiences. And we

need to prioritise community solutions that help us all. Then we will be better placed

to address what, for now, people call mental disorders.

Giselle Bahr is a clinical psychologist working in private practice. Jeltsje Keizer is a social

worker and manager of a small team within the mental health service. They founded

Excellence in Mind, an advocacy group promoting evidence-based approaches to

psychological distress.

Medicines Committee Fails to Warn Patients Sexual Dysfunction Can Be Irreversible 

Media release 

31 May 2024

Medicines Committee Fails to Warn Patients Sexual Dysfunction Can Be Irreversible 

This week Gwynneth Rees described in The Herald how antidepressants stopped her from reaching orgasm.  For her, fortunately, it was reversible.  But for many people sexual dysfunction persists even after antidepressant treatment is stopped. 

In 2019, New Zealand’s own Medicines Adverse Reactions Committee concluded there was evidence of “persistent sexual dysfunction” after treatment with antidepressants -- but didn’t make companies say that clearly in patient medicine information.

Even before that, in 2015 Pharmac warned prescribers that “sexual dysfunction is a common, often unrecognised side effect of treatment with antidepressants”.  But again, regulators didn’t make companies say that clearly in patient medicine information. 

Excellence in Mind spokesperson, Giselle Bahr says “Patients need clear information about the risks associated with antidepressants. The Health and Disability Code explicitly requires that patients have a full explanation about the unwanted effects of medicines they’re taking.  The European Medicines Authority has asked pharmaceutical companies to ‘warn that sexual dysfunction can endure after antidepressant treatment stops’.  New Zealand patients need that protection too.”

Excellence in Mind is calling on Medsafe to require that patient information about antidepressants clearly warns about possible sexual dysfunction, and warns that this may not resolve after discontinuation of the medication.

Prescription medicines not the solution to mental health

Media Advisory - attention health reporters

15 April 2024

Several advocacy groups have recently argued that the underdiagnosis of mental health conditions or disorders such as Adult ADHD is harming people's mental health because it means they are not getting access to prescription medication.

However, it is important to note that there is no established science proving that diagnosis of these conditions improves people's mental health, or that prescribing drugs is an effective way to improve people's emotional wellbeing.

Excellence in Mind is a coalition of mental health practitioners who want people to have accurate information about things that can help their emotional wellbeing. Our health system emphasises using medication over other ideas and solutions. A system where people have many more options is possible. There is a significant financial and mental wellbeing cost when we pathologise normal responses to stress. There are substantial risks associated with psychiatric medicines, while the benefits are often unproven or overstated.

We, at Excellence in Mind, invite journalists who are writing stories on mental health issues relating to prescription drugs and the pressure on doctors to properly diagnose serious conditions in short time frames, to contact us. We are a coalition of practising therapists, psychologists, nurses and social workers who work to make sure people can access impartial and researched information about psychiatric medicines and mental distress.

Response to Stuff article: 'ADHD prescribing rules costing New Zealand billions'

10 April 2024

Dear Editor,

More critical thinking is needed to protect people from being over-diagnosed and over-treated for ADHD.

Yesterday’s article in Stuff reflects the current campaign to market adult ADHD, and encourage more diagnosis and drug treatment of children and adolescents.

We are deeply concerned that New Zealanders, including parents of young children, will be misled into thinking that there is solid evidence for the benefits of diagnosis and drug treatment for ADHD. In fact these are contested opinions held by those who argue that drugs, particularly amphetamine-type stimulants, are an essential part of treatment of ADHD. 

Contrary to the statements in this article, there is evidence of over, rather than under-diagnosis of ADHD, long-term studies fail to demonstrate benefits from ADHD diagnosis and drug treatment, and current guidelines ignore the fact that the youngest children in a school year group are much more likely to be diagnosed with, and medicated for, ADHD than the oldest children in a school year group. .  

We are concerned about the potential impact of young people being defined as disabled when their inattention, over-activity and impulsivity may be part of normal variation in attention skills, or a reaction to their life circumstances, and could be differently addressed. There are many important dimensions that need to be considered when assessing attention difficulties including learning disabilities, grief, unresolved trauma responses, family dysfunction, parenting style, bullying, sleep deprivation, hunger, poor eyesight, hearing, a mismatched classroom environment and poverty.

We are acutely aware of the extreme pressure GPs are under.  It is disappointing to read that the New Zealand College of GPs believes that an ADHD assessment, which if done properly should take several hours, could be done by a GP in a short time.  It should not be within anybody’s “skillset” to diagnose ADHD in 15 minutes.  This is dangerous and our community deserves better.

We call on the Minister of Mental Health to reject the AADPA ADHD Guideline which misrepresents our current understanding of ADHD and to increase funding levels to Te Whatu Ora mental health services so that it can help people address their concerns about their attention in safe ways.    

Excellence in Mind is a group of social workers, nurses and psychologists promoting evidence-based bio-psycho-social approaches to mental health difficulties. 

Jeltsje Keizer & Giselle Bahr

Social Worker & Clinical Psychologist

Drug company removes chemical imbalance claim from consumer info

12 September 2023

Drug company, Teva Pharma, has agreed to rewrite its Consumer Medicines Information, removing references to depression being caused by a “chemical imbalance”. Excellence in Mind spokesperson, Giselle Bahr, says this is great for people searching for information. “This empowers people who may previously have believed depression was caused by a chemical imbalance to look at other causes in their environment. It enables them to consider healthier solutions”.

Read more...

Appraisal of Australian based Clinical Practice Guideline for ADHD

26 July 2023 

Below is an article recently published in the New Zealand College of Clinical Psychologists (NZCCP) journal appraising the Australian ADHD Professionals Association's (AADPA) Evidence-based Clinical Practice Guideline for ADHD. The article concludes noting:

"the Australian guideline does not include perspectives from Te Ao Māori, ignores relative age effects and evidence of overdiagnosis, was not developed by an independent, neutral entity and omits critical evidence that amphetamine treatment does not sustain benefits in the long-term and that diagnosis itself can be harmful. In our opinion the flaws in the guideline undermine any confidence we can have in the guideline as a whole." 

Alarming rise in antidepressant prescriptions to children and adolescents in Aotearoa 

15 June 2023 

Antidepressant medications dispensed to children and teenagers increased 53 per cent in the past five years, according to a recent report on the state of New Zealand’s public mental health sector.

The growth of prescribing to young people has been a source of growing unease among experts in the sector. In 2021, a study by two prominent researchers at the University of Auckland found that the benefits of antidepressants for children and adolescents are usually modest and the drawbacks can be major, including increases in suicidal thinking in some users.

ADHD diagnosis leads to poorer outcomes

12 March 2023 

A recent study has found teenagers diagnosed with ADHD as children do worse than teenagers who exhibited the same behaviours as children but were not diagnosed with ADHD.  

Diagnosed teenagers had worse sense of school membership, academic self-concept, and self-efficacy; displayed more negative social behaviours; and were more likely to harm themselves than their peers who weren’t diagnosed.

ADHD is commonly reported to affect 5-9% of New Zealand school aged children.  And clinicians are under increasing pressure to diagnosis it.  However this study suggests that children are unlikely to benefit from being labelled with ADHD and may, in fact, be harmed by it.

Lack of evidence that serotonin levels or activity cause depression

20 July 2022

Joanna Moncrieff and her colleagues have completed a comprehensive review of the evidence used to uphold the chemical imbalance theory of depression.  Careful and overarching, it includes many different approaches to investigating this issue. They conclude that after 50 years of work to prove the most influential and extensively researched biological theories of the origins of depression, it is not supported by scientific evidence.  

Te Hiringa Mahana Launch

5 July 2022

Eighteen months after the Mental Health and Wellbeing Commission began, it has announced its new name — Te Hiringa Mahana. An apt combination of determination and warmth, we look forward to seeing the Commission support the transformation of our mental health system.