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Dear Thomas,
I do my best to answer your questions below, in red. Many of the topics you address are actually not questions for the Socialstyrelsen but maybe for Läkemedelsverket, or for researchers in the field. Socialstyrelsen provides National Guidelines for decision makers in Health Care, which do not contain detailed treatment guidelines or protocolls. Socialstyrelsen’s registers provide diagnoses (ICD-10) and prescription of medication, but the registers do not provide detailed data on other parameters or outcomes.
Alle the best,
Anne-Katrin Kantzer
Medical Officer
National Board of Health and Welfare.
Från: min mail <account.dk@gmail.com>
Skickat: den 2 februari 2026 18:13
Till: Socialstyrelsen <Socialstyrelsen@socialstyrelsen.se>
Ämne: Request for Access to Documents Regarding Biological Evidence for Psychiatric Diagnoses and Treatment Mechanisms
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Answer: YES / NO Läkemedelsverket might be able to provide data on this for some medication
If YES, please provide: Document title, date, and type
Supplementary question: If no measurable thresholds exist, does Socialstyrelsen possess documentation explaining the clinical decision-making criteria used to determine when medication is indicated versus when it should be discontinued?
Answer: YES / NO se above
If YES, please provide: Document title, date, and type
- Correction Documented by Measurements
Does Socialstyrelsen possess documentation that psychiatric medication corrects a demonstrated biological abnormality, documented by measurements before and after treatment, for diagnoses covered by ICD-10/ICD-11/DSM-5?
Answer: YES / NO I am nor sure what you mean by “Documentation”. Do you refer to documentation of patient data (no, Socialstyrelsen does not possess such data) or do you refer to studies that are used as references to form Socialstyrelsens National Guidelines? In this case, you find lists with references in each guideline. Unfortunatly, the guidelines are not translated to English.
If YES, please provide: Document title, date, and type
- Children’s and Adolescents’ Neurobiology
Does Socialstyrelsen possess documentation of what psychiatric medication does to a normal, developing brain in children and adolescents, including any long-term neurobiological consequences, in relation to psychiatric diagnoses in ICD-10/ICD-11/DSM-5?
Answer: YES / NO if you refer to patient data but if you refer to studies underlying recommendations in the National Guidelines you will find reference lists in each Guideline.
If YES, please provide: Document title, date, and type
5B. Rationale for Not Testing Before Prescribing
Does Socialstyrelsen possess documentation or scientific rationale explaining why serotonin levels (or other relevant neurotransmitter levels) are not measured or tested before prescribing SSRI, SNRI, or other psychiatric medications that are purported to affect neurotransmitter function?
Answer: YES / NO you may check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
Supplementary question: If such testing is deemed unnecessary, does Socialstyrelsen possess documentation explaining how treatment can be considered causal or corrective without baseline measurements?
Answer: YES / NO you may check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
5C. Treatment Duration and “Cure” Criteria
Does Socialstyrelsen possess documentation establishing:
- The expected duration of psychiatric medication treatment required to “cure” or resolve the underlying biological abnormality
- Criteria for determining when the biological cause has been successfully corrected and medication can be safely discontinued
- Evidence-based protocols for distinguishing between “treatment completion” and “lifelong treatment requirement”
Answer: YES / NO you may check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
5D. Dependency, Tolerance, and Withdrawal
Does Socialstyrelsen possess documentation addressing:
- Whether psychiatric medications (particularly SSRI/SNRI) create physical dependency or neuroadaptation
- Documented withdrawal syndrome profiles and their distinction from “relapse” or “return of original symptoms”
- Guidelines for differentiating between: (a) withdrawal symptoms, (b) rebound effects, and (c) return of underlying condition
- Expected timelines for neurobiological normalization after medication cessation
Answer: YES / NO you may check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
5E. Diagnostic Stability and Medication Effect
Does Socialstyrelsen possess documentation examining:
- Whether psychiatric diagnoses remain stable or change when patients are medication-free versus medicated
- Studies tracking whether the same patients receive different diagnoses when assessed off-medication versus on-medication
- Evidence for whether psychiatric medications affect the diagnostic process itself (i.e., whether medicated brain states create different symptom profiles that lead to different diagnoses)
Answer: YES / NO Socialstyrelsen does not perform research studies
If YES, please provide: Document title, date, and type
5F. Comparative Efficacy: Medication vs. Natural Recovery
Does Socialstyrelsen possess documentation comparing:
- Long-term outcomes (5+ years) for medicated patients versus unmedicated patients with the same initial diagnoses
- Natural recovery rates without pharmaceutical intervention
- Studies examining whether early medication intervention improves, worsens, or has no effect on long-term outcomes compared to delayed intervention or no medication
Answer: YES / NO Socialstyrelsen does not perform research studies
If YES, please provide: Document title, date, and type
5G. Mechanism of Action Verification
Does Socialstyrelsen possess documentation demonstrating:
- The actual mechanism by which SSRI/SNRI medications produce clinical benefits (if the serotonin deficiency hypothesis is not supported)
- Alternative explanatory models for how these medications work if not through correcting a measurable biological deficiency
- Evidence distinguishing between “mechanism of drug action” (how the drug affects the brain) and “mechanism of therapeutic effect” (why that action produces symptom reduction)
Answer: YES / NO
If YES, please provide: Document title, date, and type
5H. Placebo-Controlled Long-Term Studies
Does Socialstyrelsen possess documentation of:
- Placebo-controlled studies extending beyond 12 weeks for psychiatric medications
- Long-term (1+ year) randomized controlled trials comparing medication to placebo
- Studies examining whether initial placebo-medication differences persist, diminish, or reverse over extended treatment periods
Answer: YES / NO Socialstyrelsen does not perform research studies
If YES, please provide: Document title, date, and type
5I. Informed Consent and Biological Uncertainty
Does Socialstyrelsen possess documentation or guidelines addressing:
- How clinicians should inform patients about the absence of biological testing before psychiatric medication prescription
- Required disclosures about the unproven nature of the biological basis for psychiatric diagnoses
- Standards for informed consent when prescribing medications that alter brain chemistry without prior measurement of brain chemistry
- Guidance on explaining to patients that psychiatric medications are prescribed based on symptom reports rather than biological measurements
Answer: YES / NO please check Socialstyrelens National Guidelines for depression and anxiety to see learn what type of receommendations are provided: Nationella riktlinjer för vård vid depression och ångestsyndrom (unfortunately those ore only in Swedish)
If YES, please provide: Document title, date, and type
5J. Polypharmacy and Drug Interactions
Does Socialstyrelsen possess documentation regarding:
- Evidence base for combining multiple psychiatric medications (e.g., SSRI + antipsychotic + mood stabilizer)
- Studies demonstrating that combined psychiatric medications are more effective than monotherapy for specific measurable biological abnormalities
- Guidelines for determining which biological markers indicate need for polypharmacy versus monotherapy
- Long-term neurobiological effects of psychiatric polypharmacy, particularly in developing brains
Answer: YES / NO you might check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
5K. “Treatment-Resistant” Patients
Does Socialstyrelsen possess documentation explaining:
- Why some patients are labeled “treatment-resistant” if the medication is supposed to correct a biological deficiency (i.e., why would correcting a deficiency fail in some patients?)
- Whether “treatment resistance” indicates the absence of the purported biological abnormality in those patients
- Biological markers that distinguish “treatment-resistant” from “treatment-responsive” patients before treatment begins
- Whether “treatment resistance” might indicate that the underlying causal model is incorrect
Answer: YES / NO you might check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
- TREATMENT PROTOCOLS AND TREATMENT STANDARDS
- Diagnosis-Specific Treatment Protocols
Does Socialstyrelsen possess standardized treatment protocols, treatment pathways, algorithms, flowcharts, or instructions linked to specific ICD-10 and/or ICD-11 diagnoses?
Answer: YES / NO Please read in the National Guidelines to learn more about which recommendations that are provided, for example for depression and anxiety: Nationella riktlinjer för vård vid depression och ångestsyndrom
If YES, please provide: Document title, date, and type
- Pharmacological Treatment Protocols
Does Socialstyrelsen possess documents describing initiation, dosing, dose adjustment, monitoring, treatment duration, and discontinuation of psychiatric medication per diagnosis?
Answer: YES / NO you might check this question with Läkemedelsverket
If YES, please provide: Document title, date, and type
- Age-Differentiated Protocols
Does Socialstyrelsen possess separate treatment protocols or instructions for children, adolescents, and adults?
Answer: YES / NO please check the National Guidelines Nationella riktlinjer för vård vid depression och ångestsyndrom
If YES, please provide: Document title, date, and type
- Combination Treatment
Does Socialstyrelsen possess protocols or standards for combining pharmacological and psychological treatment?
Answer: YES / NO you may check this Question with Läkemedelsverket
If YES, please provide: Document title, date, and type
- Treatment Follow-up and Effect Monitoring
Does Socialstyrelsen possess documents describing how treatment effect, side effects, deterioration, and dropout are monitored and documented?
Answer: YES / NO
If YES, please provide: Document title, date, and type
- Update and Revision Basis
Does Socialstyrelsen possess documents specifying when and on what professional basis existing treatment protocols are revised?
Answer: YES / NO
If YES, please provide: Document title, date, and type
REQUEST SPECIFICATION
I am requesting only a clear confirmation of whether the above documentation exists or does not exist in Socialstyrelsen’s possession, in accordance with Offentlighetsprincipen.
If documentation does not exist, I request an explicit confirmation of this fact.
I prefer to receive the response in electronic format.
BACKGROUND AND PURPOSE
This request is part of research into the evidence base for psychiatric treatment recommendations across different national health authorities. The purpose is to understand what documented biological evidence exists for psychiatric diagnoses and whether current pharmacological treatments have documented causal mechanisms.
Thank you for your attention to this matter.
