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Antidepressant Withdrawal
What we Know and Don’t Know

Q. My Doctor/Psychiatrist told me that I have to take an antidepressant to correct a chemical imbalance in my brain, is this true?

A. No, it is a myth, we cannot test or measure the state of neurotransmitters in your brain, the American Psychiatric Association disavowed this myth in 20111. It is a pharmaceutical company invention2.

Q. How many people experience withdrawal effects?

A. It varies according to which drug is used, at what dosage, and for how long. Recent studies3 are showing the number affected to be greater than 50% of those taking the drugs. The UK Royal College of Psychiatrists did their own survey4 (now removed) which showed that 63% reported withdrawal effects.

Q. Why does my doctor/psychiatrist keep saying ‘discontinuation syndrome’ when I mention withdrawal?

A. Discontinuation syndrome is an invented term5 which minimises the role of the drug in the harm caused and steers users away from addiction terminology. While dependence and withdrawal have some features in common with addiction, they are not accurately described using just this approach. What you are experiencing is an effect of withdrawing from a drug, not of discontinuing treatment.

Q. Why does my doctor insist that ‘once the drug is out of my system’ I will be fine?

A. Because not all doctors understand the effects of antidepressant drugs on the brain6. A heavy drinker or smoker may suddenly stop drinking/smoking, but the effects on their brain and nervous system continue to be felt long after they have quit. Antidepressant drugs change the brain in ways we don’t currently understand. These adaptations7 to the drug are responsible for withdrawal effects.

Q. What does withdrawal feel like?

A. It’s a highly variable experience ranging from mild symptoms which pass quickly, to profound symptoms that sometimes persist for many years. In a 2017 survey8, 46% of those reporting withdrawal symptoms described them as ‘severe’. Most common reported symptoms9 are insomnia, dizziness, fatigue, digestive problems, anxiety, panic, depression, agitation. Withdrawal symptoms can sometimes mimic depressive or anxious states but should not be confused with relapse10.

Q. I am worried about dependence, what should I do?

A. The most important thing is never stop your drugs suddenly, this can be dangerous. Talk to your doctor but be prepared as many doctors do not have the information to be able to help. Withdrawal is a unique experience, with no fixed rules. There are some excellent and reliable online sources for help including:

REFERENCES:

  1. Psychiatry’s New Brain-Mind and the Legend of the “Chemical Imbalance”
  2. Is Depression Just Bad Chemistry?
  3. How many of 1829 antidepressant users report withdrawal effects or addiction?
  4. RCPsych survey (now deleted)
  5. Antidepressant Withdrawal Syndrome
  6. One Dose of Antidepressant Changes the Brain, Study Finds
  7. The Psychoactive Effects of Psychiatric Medication: The Elephant in the Room
  8. How many of 1829 antidepressant users report withdrawal effects or addiction?
  9. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review
  10. Relapse vs. Withdrawal: The Principles of Discontinuation Syndrome

My six-point plan for improving the prescribing of psychotropic drugs

The British Medical Association is calling for a 24 hour, national helpline for people dependent on prescription drugs this is a great first step but we could and should do more. This is my six-point plan to improve the prescribing of psychoactive drugs, please share this if you agree.

  • Provide better training and updated NICE Pathways guidance for GPs on the benefits versus risks of psychotropic medications to allow patients to make an informed choice about treatment.
  • When a psychoactive drug has been prescribed, a formal review meeting should be arranged at six weeks, if the patient shows no improvement, the presumption should be that drug treatment stops unless there is compelling medical evidence to continue.
  • Provide specific guidance on withdrawing from psychoactive medications to support GPs and assist them in having withdrawal discussions with their patients. Give pharmacists a greater role in supporting users with better information and guidance specifically for those withdrawing.
  • Patient Information Leaflets (PILs) should be updated to include information on stopping your medication and how best to avoid withdrawal problems.
  • Set up high quality, randomised controlled trials to provide evidence of the best way to withdraw from a particular drug.
  • Trial and implement Tapering Strips to assist in safely withdrawing users from psychoactive medications.

Other suggestions for help and support:

  • An online portal where users can get accurate information on stopping or reducing prescription medications with online chat access to health professionals (g.p/psychiatrist/pharmacologist).
  • A forum for users seeking support, perhaps moderated by healthcare professionals.
  • A dedicated user group that can use real experiences as a basis for future action/investigation.
  • Make visible information on the long-term risks of psychoactive drugs including publishing all available long-term studies (e.g. opentrials.net)
  • Keep a central database of drug withdrawal effects for reference and future study, allow reporting of withdrawal effects via the yellow card scheme.
  • Dedicated helplines should be provided and funded by pharmaceutical companies for users of their products.

Please sign my petition, Click HERE

Campaign Aims

  • Raise awareness of the difficulties users face when they want to stop taking psychoactive drugs.
  • Encourage and support conversations between users, mental health professionals and policy-makers.
  • Promote the idea of drug tapering kits and to encourage Pharmaceutical manufacturers to better support the users of their products.

What we want

We want pharmaceutical manufacturers to produce “drug tapering kits” which provide the most commonly prescribed medications in decreasing doses over a period of time.

We need tapering kits to help the millions of users of psychoactive pharmaceutical drugs because:

  • Many tablets are only available in increments that are so large that they are useless for gradual lowering (tapering) of the dose.
  • Liquid forms for some medications are available but tend to be hugely expensive and therefore the NHS will not provide them.
  • Pill cutting is, at best, a hit and miss affair.
  • Some doctors and psychiatrists confuse the symptoms of withdrawal with a return of the symptoms that the tablet was originally prescribed for.
  • These kits would save a significant amount of time for General Practitioners, Psychiatrists, Community Mental Health teams and Pharmacists.
  • They would help users of psychiatric medications stop taking them safely and in a controlled fashion, giving them control over their drug intake.