Lasting Damage from Prescribed Drugs

Joanna Moncrieff, MD
74
10814

The recent furor caused by publication of evidence about the serious nature of antidepressant withdrawal made me reflect on the lasting damage that can sometime be done by prescription drugs, and how it has often taken concerted efforts by users of these drugs to bring these effects to public attention.

Historically, the medical community has been slow to appreciate the extent to which drugs can interfere with and alter normal brain and body functions in both predictable and unpredictable ways. It took psychiatrists a long time to acknowledge that tardive dyskinesia was caused by neuroleptics, and they tried hard to pin it on something else (schizophrenia).1 It has taken three decades for the withdrawal effects of antidepressants to be taken seriously. The prescription opioid epidemic in the United States continues despite mounting evidence that the drugs can exacerbate chronic pain rather than relieve it.2

Withdrawal effects

Withdrawal effects are, in themselves, an indication that the body has been altered by the ingestion of a drug. We associate withdrawal effects with long-term use, but in fact, the body can change, temporarily, even after a single dose of a drug. Animal studies show that one acute treatment with an opiate provokes a period of heightened sensitivity to pain (known as hyperalgesia), which follows after the direct analgesic effect of the drug and lasts for a few days.3 Similarly, taking sleeping pills for just one or two days improves sleep initially, at least slightly, but when the pill is stopped, people find it even more difficult to sleep than they did before they took it.4 This is sometimes referred to as ‘rebound’ insomnia, and ‘rebound’ is the general term used to describe these compensatory-type effects that occur after the acute effects of a drug have worn off.

When drugs have been taken for long periods, withdrawal symptoms can be more severe and longer-lasting. They usually last for weeks, even if the drugs are reduced gradually. After discontinuation of some drugs, however, the effects can sometimes go on for months and even years. In these instances, the body is taking a long time to return to its pre-drug state, and it seems that in some cases it never quite does, and the drug-induced alterations are permanent.

Protracted withdrawal following benzodiazepine cessation was recognised back in 1991 by Heather Ashton.5 She documented withdrawal symptoms such as anxiety, tinnitus, paraesthesia (burning pain, tingling and numbness), that lasted for many months and sometimes years. In most, though not all, instances there was a gradual improvement over time. Drugs like alcohol and opiates seem less likely to cause protracted withdrawal, but the hypersensitivity to pain that is a recognised feature of opiate withdrawal took up to five months to normalise in an experiment with recently detoxified opiate addicts.6

Evidence on antidepressant withdrawal suggests a picture similar to the benzodiazepines. There is a range of intensity and duration of withdrawal, with not everyone experiencing debilitating or even noticeable symptoms, but there are numerous reports of withdrawal symptoms being severe and protracted. An analysis of respondents on an antidepressant withdrawal web forum that I conducted with some colleagues revealed that withdrawal symptoms following reduction or cessation of Selective Serotonin Reuptake Inhibitors (SSRIs) were reported as lasting an average of almost two years (91 weeks), and those associated with Serotonin and Noradrenalin Reuptake Inhibitors (SNRIs) lasted just under a year on average (51 weeks).7 Although people resorting to an online forum are likely to be those experiencing the most difficulty with withdrawal, this nevertheless shows that long-lasting effects are a significant problem for some people. As Davies & Read concluded in their recent review, it is difficult to estimate an overall average duration of symptoms from current research, especially as most studies were not set up to assess this directly, but reports of symptoms lasting several months are common across many recent studies.8

Most reports suggest that symptoms of benzodiazepine and antidepressant withdrawal usually improve gradually even years after the drugs are stopped. Worryingly, however, Ashton’s initial description of protracted benzodiazepine withdrawal includes one or two cases where symptoms were still problematic several years after withdrawal, in some cases even when people had resumed benzodiazepines. This suggests that occasionally drugs can induce permanent changes in brain functioning.

Some accounts indicate that protracted withdrawal followed from abrupt discontinuation of the medication in question.9 Within addiction services in the United Kingdom there seems to be increasing appreciation that rapid withdrawal of benzodiazepines is undesirable, although I can find no discussion of a possible link between rapid detoxification and protracted withdrawal effects in any official literature or guidance. However, Ashton’s description of persistent withdrawal states mostly involved people who were undergoing, or had completed, a slow reduction, so it may be that although abrupt discontinuation is likely to be more risky, gradual reduction may not always protect against experiencing a complicated and prolonged withdrawal.

Tardive dyskinesia

We have known for decades that some psychiatric drugs can produce permanent and detrimental changes to brain function. Tardive dyskinesia, the syndrome of abnormal movements that is associated with a degree of cognitive impairment, was recognised back in the 1960s to be a consequence of neuroleptic administration. It was noted that it persisted after neuroleptics were stopped, sometimes for months and even years, depending on how long people were followed up for.

It has been proposed, although never demonstrated, that tardive dyskinesia is caused by ‘supersensitivity’ of dopamine receptors. The abnormal movements are similar to those of Huntington’s Chorea which are associated with excessive dopamine activity.10. The fact that tardive dyskinesia often occurs while people are still taking neuroleptics suggests that the brain overcompensates for the effects of dopamine-blocking drugs. In attempting to balance out their effects, the body overshoots, and disrupts normal mechanisms for movement control along with more general functions that impact on cognition.

The recently characterised condition termed opioid-induced hyperalgesia may represent a similar situation, with the body over-adjusting to the presence of pain-suppressing drugs resulting in increased levels of pain. Although opioid-induced hyperalgesia typically occurs during opioid therapy, there is little research on whether or not it persists after the drugs are withdrawn.

Post-SSRI sexual dysfunction

Further evidence of long-lasting changes associated with antidepressants, in this case, comes from the emerging literature on post-SSRI sexual dysfunction. It is well established that SSRIs commonly impair sexual function while they are being taken, but there are mounting reports of persistence of some difficulties following cessation of the drugs for months and sometimes years.11 Persistent sexual impairment is also demonstrated in male rats treated with SSRIs during adolescence.12 13 It is difficult to estimate the prevalence of persistent sexual dysfunction given the currently limited data, but one survey identified that 34% of respondents showed evidence of possibly having the condition, and 4.3% showed a high probability of having it.14 I have heard some psychiatrists protest that post-SSRI sexual dysfunction is ‘psychological’ and simply a re-emergent symptom of an underlying depression, but the fact that it is consistent with known acute effects of SSRIs and with animal research into lasting effects makes it difficult to uphold this position. It seems more likely that it is another example of a long-lasting, and possibly occasionally permanent, change to normal bodily functions induced by some prescribed psychiatric drugs.

Increased risk of mania and psychosis

Research that suggests the discontinuation of some drugs can increase the risk of having an episode of an underlying psychiatric disorder, such as mania or psychosis, also indicates how long-term use of some prescribed drugs can cause significant changes to brain processes. The evidence is most clear for lithium, where studies show that in people with a diagnosis of manic depression (bipolar 1), the risk of having an episode, especially of mania, is higher after stopping lithium than it was before lithium was started.15 16 17 This is true despite the fact that lithium is not commonly reported to provoke a severe, acute withdrawal reaction. Despite this, it seems the removal of the neurological suppression produced by the sedating effects of lithium can trigger the state of hyperarousal known as mania, possibly through a delayed rebound type of effect. Some research suggests a similar picture in people diagnosed with psychosis or schizophrenia who have been treated with long-term antipsychotics. Evidence shows that the risk of relapse is heightened in the first few months following discontinuation, and declines thereafter, suggesting that discontinuation is not just revealing an underlying tendency, but is provoking an episode that might not otherwise have occurred, at least at that point.18 Thus it seems that the alterations produced by long-term treatment with certain sedative drugs increase a person’s vulnerability to having an acute episode of mania or psychosis. Some argue that this effect also occurs with antidepressants,19 although the evidence for this is less clear.

Lack of research

It is astonishing that iatrogenic problems such as persistent diseases and dysfunctions induced by prescribed drugs have received so little attention from the research community. We remain uncertain about the proportion of people who can expect to experience an adverse withdrawal-related reaction following different lengths of treatment with different drugs. We know very little about how long such withdrawal reactions are likely to last, and indeed whether they may sometimes be permanent. We do not know for certain whether rapid reduction increases the risk of protracted withdrawal, nor whether very gradual reduction can prevent its occurrence. The occurrence of post-SSRI sexual dysfunction is probably unknown to most prescribers, and there is little research on its prevalence or duration.

The mechanisms of these effects also remain obscure. There is research on the mechanisms of acute withdrawal from opiates and benzodiazepines, there is little research into what produces states of prolonged withdrawal. There is no research on the mechanisms underlying antidepressant withdrawal or post-SSRI sexual dysfunction.

Yet is has been estimated that around 16% of the population of the United Kingdom are taking antidepressants currently20, and the latest data from the United States, from 2011-2014, put the figure at 12%.21 If even a small proportion of these people experience protracted withdrawal or post-SSRI sexual dysfunction, it is a sizeable problem! Furthermore, recent figures from England show that prescriptions have doubled in the last decade, now topping 70 million for a population of 56 million. It is unbelievable that the leaders of the medical profession are so unconcerned about this situation that the president of the Royal College of General Practitioners cautioned against viewing the increase in prescriptions ‘as a bad thing’.22

Implications

There is a large-scale failure to appreciate the risks involved in taking drugs that alter brain function on a long-term basis. Some of these risks are foreseeable, some less so. We should have been able to anticipate that SSRIs and other new drugs for depression and anxiety would produce withdrawal syndromes, although once again we were taken unawares, and there seems to have been no research into this possibility before the drugs were launched. A syndrome like tardive dyskinesia or opioid-induced hyperalgesia should remind us, however, that the effects of drugs cannot always be predicted, and that we must always be vigilant for complex and unusual reactions.

The fact that it has taken single-minded and dedicated campaigners, many of them users of the drugs concerned, to bring these effects to the attention of the scientific and professional community is shameful, and highlights the naivety of the medical profession.

To anticipate some of the criticism I will receive from people who feel that medication has helped, I am not saying that these drugs should never be considered. I have certainly seen situations in which someone has managed to stop drinking harmful amounts of alcohol through using small doses of a benzodiazepine, for example, and benzodiazepines are definitely the least dangerous option in this situation. I also believe that neuroleptics, despite their many noxious effects, are sometimes preferable to a severe and intractable psychosis. People must have all the facts though. Doctors must understand and explain that drugs change the brain, and other parts of the body, in ways that we do not fully understand, that are almost always harmful to some degree, and that may be irreversible.

Show 22 footnotes

  1. Moncrieff J. The Bitterest Pills: the troubling story of antipsychotic drugs. London: Palgrave Macmillan; 2013.
  2. Velayudhan AB, G.; Morely-Forster, P. Opioid-induced hyperalgesia. Continuing Education in Anaesthesia, Critical Care and Pain. 2014;14(3):125-9.
  3. Celerier E, Rivat C, Jun Y, Laulin JP, Larcher A, Reynier P, et al. Long-lasting hyperalgesia induced by fentanyl in rats: preventive effect of ketamine. Anesthesiology. 2000;92(2):465-72.
  4. Soldatos CR, Dikeos DG, Whitehead A. Tolerance and rebound insomnia with rapidly eliminated hypnotics: a meta-analysis of sleep laboratory studies. Int Clin Psychopharmacol. 1999;14(5):287-303.
  5. Ashton H. Protracted withdrawal syndromes from benzodiazepines. JSubstAbuse Treat. 1991;8(1-2):19-28.
  6. Treister R, Eisenberg E, Lawental E, Pud D. Is opioid-induced hyperalgesia reversible? A study on active and former opioid addicts and drug naive controls. J Opioid Manag. 2012;8(6):343-9.
  7. Stockmann T, Odegbaro D, Timimi S, Moncrieff J. SSRI and SNRI withdrawal symptoms reported on an internet forum. Int J Risk Saf Med. 2018;29(3-4):175-80.
  8. Davies J, Read J. A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav. 2018.
  9. Anonymous. Rapid withdrawal and misprescribing of a benzodiazepine leads to £1.35m settlement for Luke Montagu, CEP co-founder. 2015 [Available from: http://cepuk.org/2015/07/18/rapid-withdrawal-misprescribing-benzodiazepine-leads-1-35m-settlement-luke-montagu-cep-co-founder/.
  10. Cepeda C, Murphy KP, Parent M, Levine MS. The role of dopamine in Huntington’s disease. Prog Brain Res. 2014;211:235-54.
  11. Bala A, Nguyen HMT, Hellstrom WJG. Post-SSRI Sexual Dysfunction: A Literature Review. Sex Med Rev. 2018;6(1):29-34.
  12. de Jong TR, Snaphaan LJ, Pattij T, Veening JG, Waldinger MD, Cools AR, et al. Effects of chronic treatment with fluvoxamine and paroxetine during adolescence on serotonin-related behavior in adult male rats. Eur Neuropsychopharmacol. 2006;16(1):39-48.
  13. Simonsen AL, Danborg PB, Gotzsche PC. Persistent sexual dysfunction after early exposure to SSRIs: Systematic review of animal studies. Int J Risk Saf Med. 2016;28(1):1-12.
  14. Ben-Sheetrit J, Aizenberg D, Csoka AB, Weizman A, Hermesh H. Post-SSRI Sexual Dysfunction: Clinical Characterization and Preliminary Assessment of Contributory Factors and Dose-Response Relationship. J Clin Psychopharmacol. 2015;35(3):273-8.
  15. Cundall RL, Brooks PW, Murray LG. A controlled evaluation of lithium prophylaxis in affective disorders. PsycholMed. 1972;2(3):308-11.
  16. Baldessarini RJ, Tondo L, Viguera AC. Discontinuing lithium maintenance treatment in bipolar disorders: risks and implications. BipolarDisord. 1999;1(1):17-24.
  17. Suppes T, Baldessarini RJ, Faedda GL, Tohen M. Risk of recurrence following discontinuation of lithium treatment in bipolar disorder. ArchGenPsychiatry. 1991;48(12):1082-8.
  18. Viguera AC, Baldessarini RJ, Hegarty JD, van Kammen DP, Tohen M. Clinical risk following abrupt and gradual withdrawal of maintenance neuroleptic treatment. ArchGenPsychiatry. 1997;54(1):49-55.
  19. Fava GA. Can long-term treatment with antidepressant drugs worsen the course of depression? JClinPsychiatry. 2003;64(2):123-33.
  20. (DHSC) DoHaSC. Hansard- prescription drugs: written question 128871 London2018 [Available from: https://www.parliament.uk/business/publications/written-questions-answers-statements/written-question/Commons/2018-02-21/128871/.
  21. Pratt LA, Brody DJ, Gu Q. Antidepressant Use Among Persons Aged 12 and Over:United States,2011-2014. NCHS Data Brief. 2017(283):1-8.
  22. Guardian T. Antidepressant prescriptions in England double in a decade. London: The Guardian; 2019 [updated 29th March 2019. Available from: https://www.theguardian.com/society/2019/mar/29/antidepressant-prescriptions-in-england-double-in-a-decade.

74 COMMENTS

      • I was never helped with any of these drugs, but I didn’t have a mental illness. These drugs are used by doctors to gaslight people, in order to cover up medical evidence of prior malpractice and the abuse of one’s child. And to silence, discredit, and cover up – for profit – the sexual assault of millions of child abuse survivors.

        https://www.indybay.org/newsitems/2019/01/23/18820633.php?fbclid=IwAR2-cgZPcEvbz7yFqMuUwneIuaqGleGiOzackY4N2sPeVXolwmEga5iKxdo
        https://www.madinamerica.com/2016/04/heal-for-life/

        Thank you, Joanne, for this critical analysis of these neurotoxic drugs. I agree the medical community’s now claimed ignorance of the harmful effects of the psychiatric drugs is “shameful.”

        But I’m quite certain “naivety” is too generous, since all doctors were taught in med school that both the antidepressants and the antipsychotics can create “psychosis,” via anticholinergic toxidrome. It’s downright evil to mass drug a population’s children with amphetamines. And all people, except today’s doctors, know opium is a dangerous, mind altering, and addictive drug. Unfortunately I’d have say disingenuous, unethical, avarice at the expense of other humans’ lives inspired, hypocritical, or insanely stupid would be a better description of today’s medical community.

  1. hi. thank you for this, Dr.Moncrieff.

    speaking as an increasingly disillusioned “patient,” this is ridiculous. and the level of dogma that is passed off as “fact,” “truth,” etc. within the mental health industry regarding psych drugs is appalling.

    not to make all psychiatrists sound evil, but I do think they use drugs as a punsihment and reward system. Having experienced the “punishment” end– which, in my case involved rapid benzodiazepine tapers and being coerced into taking dangerous psych drugs– far more than any “reward” end, I must say: people/”patients” need quality information -before- the first prescription, the first psychotherapy session, the first melt-in-your mouth Mother’s Little Helper…

    but I doubt it wil ever happen, because psychiatry thrives on force, fraud, and coercion (I think that’s Szasz, btw). And…

    as much as I appreciate -your- honesty, your transparency, etc., you are one of very few psychiatrists who are willing to share what they -really- know about the drugs with people/”patients.” That, of course, raises another important question: if psychiatrists start respecting the people who come to them for help, provide honest and accurate information, and explain the limitations of their field with the people/”patients” they deal with…

    would psychiatry, as a profession, wither and die?

    Thanks again 🙂

  2. Good article, for the most part.

    But the notion that so-called “anti-depressants” or neuroleptics are sometimes helpful is just not true. Such assertions rest on the erroneous notion that there is such a thing as “mental illness” or “psychosis.” Are the drugs bad? Yes. Does Moncrieff do great work to show why the drugs are bad? Yes. But as long as the prevailing myth of “mental illness” remains unaddressed, people will continue to produce and distribute drugs in the vain hope that some mysterious “chemical imbalances” in the brains of unwitting victims of psychiatry will be fixed.

    Of course Joanna has seen how drugs “help” the “psychotic.” This is always the perception from the outside. Someone who has been labeled as “psychotic” gets drugged into a chemical stupor and stops acting “psychotic.”

    This is how she puts it: “I also believe that neuroleptics, despite their many noxious effects, are sometimes preferable to a severe and intractable psychosis.”

    Nonsense.

    • Psychiatry is a pseudoscience, a drug racket, and a means of social control. It’s 21st Century Phrenology, with potent neuro-toxins. Psychiatry has done, and continues to do, far more harm than good. So-called “mental illnesses” are exactly as “real” as presents from Santa Claus, but not more real. The DSM is in fact nothing more than a catalog of billing codes. There, now you know what MY painful experience with psychiatry and psych drugs has taught me! But, having said that, having spoken the TRUTH, we still must allow for an uncomfortable reality:
      In SOME people, SOMETIMES, SOME low dose of SOME drug MIGHT actually be helpful, in the short-term.
      To say, for example, “No drug has ever helped anybody”, which you appear to be doing, SlayingDragon, is just unscientific, and probably wrong. *SOME* people actually LIKE their psych drugs. Yeah, it’s crazy, I KNOW! But’s it’s also an inconvenient truth….
      But of course, even *IF* a drug actually helped somebody, that is still NOT even good evidence that so-called “mental illnesses” are in fact “real”, much less proof of it….

      • “In SOME people, SOMETIMES, SOME low dose of SOME drug MIGHT actually be helpful, in the short-term.”

        Nope. Here’s the distinction. Many people may be deceived into thinking that drugs help them, it is true. This is what Dr. Breggin calls “medication spellbinding.” Lots of people “like” their drugs, but that doesn’t mean that the drugs are “helping them.” Lots of people like cigarettes, alcohol, cocaine, lsd, heroin, and so forth. Lots of people like a lot of things.

        But you’re right that psychiatry is a pseudo-science and that “mental illness” is a myth.

    • There is this impression among some people that Tardive Dyskinesia is some kind of acceptable trade off for ‘drug induced mental stability’. Also, neuroleptics, as has been pointed out, time and time again, have a way of transforming what might have been a transitory psychotic episode into “intractable psychosis”, or permanent impairment of the thought processes. I would suggest, on the other hand, that psychosis is preferable to brain damage, and brain damage is exactly what you get with long term routine drug taking regimens. I think the physician’s aversion to madness, in these instances, is much more excessive and exaggerated than it needs to be.

      • Frank,

        Tardive Dyskinesia (I believe) is understood to refer to “late onset movement disorder” with stereotypical symptoms attached to it.

        But neuroleptics can cause lots of permanent neurological (movement) problems that seriously affect a person’s ability to function (“slowed down movement”, “muscle weaknness”, “poor co ordination”).

    • No, not really a good article at all. This kind of piece is just a limited hangout that actually helps to solidify the system. Unless and until people like Moncrieff are willing to get off the fence and question the entire drugging/electrocution/diagnosis enterprise – which of course they will never do – they won’t make the smallest dent in this.

    • Let me play devil’s advocate DS.

      Speaking from personal experience when I first took a tiny amount of the neuroleptic Stellazine I had been suffering severe social anxiety as a college freshman. It shut down the part of my brain used for tensing up so I made friends and could stay on campus.

      Looking back though, alcohol would also have had similar benefits. “Exposure therapy” would have been the real answer to my problems.

  3. Dr. Joanna you can never fully appreciate the torment these drugs cause if you haven’t taken any. Emotionally versus chemical reactions. I hope you listen to what your patients say and don’t dismiss it, but I’m sure you don’t.

    Haldol (10 mg) caused me seizures, Parkinsonism, and worsened my OCD and caused full blown psychosis during my fits. No one believed me. 🙁 The doctors told my parents I was lying and if I took those drugs (I did! I did!) everything would be fine.

    It’s over…thank You God! But being drugged for 25 years–on a cocktail between 1994-2016–has left its mark. My life never will be a good one even if it is a few years longer.

      • Rachel,
        I agree with you 100%. She has never taken the drug and don’t know what they do. The drug companies will not give you the data from the drug trials and for good reason. Not everyone who’s harmed by these drugs speaks up for fear of reprisal and being labeled, “well of course, they’re mentally ill so you really cannot take them seriously”. And good for you getting off the toxins! Congratulations! I think this crap should be banned under the heading “a safety hazard” because they are.

  4. Dr Moncrieff states ‘It is unbelievable that the leaders of the medical profession are so unconcerned about this situation…’

    Indeed. But she has claimed (2016) to be a ‘dissident’, while for the last five years, and possibly longer, her groups (Critical Psychiatry Network, CEPUK) have existed in a cosy duopoly with those ‘medical leaders’, failing to seriously challenge the pharmaceutical industry’s influence on mental health practice in the UK.

    My own attempts to add to the range of voices attempting to reform ‘Pharma-psychiatry’ resulted in suspension from ‘medical practice’ eleven days ago. Dr Moncrieff and her colleagues have failed to comment, suggesting that they see it as an opportunity to continue with business as usual: https://drnmblog.wordpress.com/

  5. Dr. Moncrieff:

    I am increasingly of the belief that doctors should not be able to prescribe these pills any longer and parents should not give them to their children unless they have first taken a course on the risks which is developed and/or informed 100% by psychiatric survivors. I think this would go a long way in solving the problem of reckless prescribing and failure to conduct research that could inform clinical practices as it concerns de-prescribing.

    I would go even further and require that prescribers and parents be legally REQUIRED take a ‘sample’ of what they are dishing out. I took one of my son’s pills once and it took me three days to recover cognitively and physically. Taking even a small bit of another’s prescription medication may be illegal but I did it to find out what it would do to my brain and it reinforced in me the belief that psychiatry lies and kills and it had the effect of radicalizing me. I now feel that our society urgently needs to correct the power imbalance between doctors and patients before more lives are lost.

    Thankfully, my son withdrew cold turkey from Seroqel without any major withdrawal difficulties (he had only been on it for one month during a crisis) and with the help of yoga, friendship, cross fit, ballet, kickboxing, free counseling from the Returning Veterans Project, and hobbies such as harp playing he is med free and gainfully employed.

    Now our family is focusing on supporting our others adult child’s withdrawal from Clozoril.

    How can one find an expert in tardive dyskinisia? I don’t think she has tardive psychosis, thankfully. She still experiences long periods of daily clarity that we build on. But several years of clozoril usage have made a noticeable cognitive impairment around her focus and memory which prohibit her from successfully making goals, and following through. It is hard for her to hold onto a thought longer than a minute. David Oaks described Thorazine as a ‘wrecking ball to the cathedral of his mind’ and this comes close to describing what I observe in her.

    I think many younger survivors are starting to articulate a widespread common drug induced impairment that has often been blamed on the progressive nature of ‘schizophrenia’, inability to simply THINK. Executive functioning is a spectrum of different functions such as focus, memory, and organizing. These functions are impaired by long term neuroleptic use, I’m convinced. Just as there is a lack of research around withdrawal, there is a lack of research around cognitive impairments that are drug induced. Can you refer us to any studies where this link is established?

    I also believe that my daughter is experiencing a less common form of dyskinisia that affects her respiratory tract so that many times, within about twenty minutes of taking her daily dose (at night) she feels that she is suffocating. It is very scary and unpleasant and causes her to panic. It is scary side effects like this that caused her to be med compliant on many occasions which gave the state it rational to lock her up for years and drug her by force.

    I believe that past trauma of psychiatric interventions coupled with cognitive impairment impacts her ability to talk cogently and honestly about side effects with her prescriber and I am afraid to get involved with her psychiatrist for several reasons:
    1) intruding on her privacy and independence.
    2) My own past failed attempts to influence a prescriber to de-prescribe which sometimes backfired
    3) The fear that the prescriber will simply give her another med to counter the side effects, the prescription cascade, so to speak
    4) Being forbidden to be a part of her life due to ‘parental lack of insight’

    Any suggestions as to an expert that we could take her to to sort out the side effects from the trauma? Especially someone who is an expert on dyskinisia?

  6. I already wrote a similar comment, but I want to pay attention: As long as people believe in random mutations, psychiatry will remain punitive.
    As for antipsychotics, this is the same approach as in kindergarten, when children who are noisy are forced to stay in beds, when all the other children have already woken up.

      • It seems like all we can do now is get a diagnosis of schizophrenia for no reason, and then find the cause and try to prove that the doctors are wrong.
        I find that psychiatry is closely related to Darwin’s theory. The key word here is “Random”. As a programmer, I know that with computer it is impossible to create real randomization. So why we are waiting for it from nature? And if everything is connected in nature, then such a basic symptom of psychiatry as paranoia (synchronicities) can no longer be regarded as medical pathology. Maybe real chaos in a form of quark and gluon field fluctuations is something what we usually call God, and the more complex the biological system, the more connections it have.

  7. The early work of Professor Malcolm H. Lader and his colleagues documented the first indication of anatomical brain changes associated with benzodiazepines using CAT scan, which revealed abnormalities in at least half of the patients examined in the study, with two patients having definite cortical atrophy. The patients were either dependent on or experiencing a protracted withdrawal syndrome from, benzodiazepines. The results warranted further research as they were suggestive of brain damage. https://www.benzo.org.uk/amisc/lader4.pdf

    • Cole, I very much respect the fact that you included a link to actual evidence– and by all means, keep it coming, as I believe in healthy debate and I want to keep an open mind!

      At the same time, I have to note that the scans noted in the .PDF only reflect what was seen after benzo treatment. We have no idea what their brains looked liked beforehand, and there was no mention of control for other variables that might explain the atrophy. I have always been very skeptical of claims that even long-term benzo usage causes brain damage for reasons that, I must admit, are even more anecdotal: I’ve taken one milligram of lorazepam daily for at least 20 years, and I have noticed no impairment in executive function whatsoever. On the contrary, I seem to have a better memory for where my keys and phone are than people half my age (I’m in my early 60s) and I work in an academic environment with scientists and students who routinely make positive comments about my memory and executive function.

      While it’s certainly true that my memory of what happens right before I fall asleep– and approximately 90 minutes after I take the drug– is not as sharp as the rest of the day, even those memories are accessible, though with more effort. What really destroys my memory seems to be fatigue and anxiety. It is an in-vivo experiment, to be sure, and I acknowledge that it’s quite possible that I’ll be posting here 5 or 10 years from now complaining that I have some serious neurological problem. But I tend to doubt it.

      I do find that I find it almost unbearably frustrating to have conversations with friends over 45 who drink more than two units of alcohol a night– and even some who only drink two. It seems like they absolutely cannot keep up their end of the conversation; their processing seems noticeably slower, and their short-term and long-term memory seems obviously, and grossly impaired. (This speaks to Moncrief’s thoughts about benzos vs. ETOH, which I thought were very brave. I second her opinion, and I know it’s not a popular one.) When I stopped drinking about five years ago, my memory and sense of direction, improved dramatically; I think there’s very robust evidence that ETOH causes cerebral atrophy, and I did drink very heavily for decades, so I am at a lost to explain why the function returned. Again, I don’t mention all this because I want to pick a fight about this, I’m genuinely puzzled.

      • Since Benzos and alcohol both act on the same systems in the brain, if alcohol causes brain damage, it stands to reason that benzos would do the same eventually. Perhaps it depends on the person, dosage, and length of exposure, but it seems we ought to expect benzos to do such damage and be surprised if it doesn’t.

        • I think doctors prescribe benzos for the same reason that some people prescribe so-called recreational drinking. Excuse me, as a drinker, for saying so, but I recognize my drinking as a vice. I don’t get the idea that people taking benzos are aware that doing so is a vice as well. If doctors got the idea, maybe they would, as they should, cease prescribing them, and while they are at it, cease prescribing them to excess. Anxiety is not a disease, anxiety is a survival mechanism of the species, and there is no relief from anxiety like the expertise and facility that comes of experience.

        • Steve, I don’t quite follow that. Doesn’t it seem more likely that alcohol damages the brain through it’s overall toxicity– the fact that it poisons the body in so many different ways: stomach, liver, kidneys, blood vessels. I think the gross morphological changes in the brain caused by alcohol are more likely due to vascular damage, not anything having to do with the GABA system. (Certainly, GABA affects a wide variety of systems, and it’s possible there are harms associated with that, but they seem more likely to be subtler than the changes noted in Cole’s PDF.) Frank, I agree that anxiety is not a disease, but I do not feel there is any clinical utility or moral imperative to classify any behavior as a ‘vice,’ or any particular virtue to labeling one’s own behavior in that way.

          • You make a valid point. However, in terms of brain damage specifically, it seems likely that both could cause such damage in a similar way due to similar effects. They use benzos, for example, to detox someone from alcohol, so they’re almost interchangeable in terms of effects on the brain. As such, their damage profiles in the brain should be similar. It may be that the livers and hearts of the benzo users are not impacted in the same manner, though again, it may be very much dependent on dosage control, or lack of same.

          • There is certainly what might be called a clinical utility in preventing overdose. Our prescription drug culture with fentanyl has grown ever more deadly, and it could have been predicted with the letting in of otherwise illegal substances through the side door. Pharmaceutical companies want to capitalize on the fact that drugs are not officially addictive when they are prescribed by physicians. Drugs support evasions, and evasions aren’t effectively solving problems with the resulting bad outcomes, death and injury.

        • Steve McCrea wrote: “Since Benzos and alcohol both act on the same systems in the brain, if alcohol causes brain damage, it stands to reason that benzos would do the same eventually.”

          According to neuroscience, Benzos and alcohol do not act on the same systems in the brain. It does not stand to reason that benzos have the same damaging effects on the brain as alcohol. Benzos do act on the GABA system, as well as many other hypothetical systems, but not in the same way as alcohol, which also acts on many other hypoythetical brain systems, and not all of the same ones, or in the same way.

          Brain damage is cell death, necrosis. It’s true that benzos and alcohol cause necrosis. But not in the same way, and not in the same patterns, and not predictably in all people.

      • You are one anecdote. So am I. I can take your anecdote and raise you a “I have suffered for over eight years in what’s called a ‘protracted withdrawal syndrome’ by some, but what really is persistent symptoms of neurotoxicity post cessation.” I have extreme impairment, including to both short- and long-term memory (in addition to a plethora of other physical, mental, and psychological symptoms); this all happened from age 25 to 40– including the five years of drugging and then the many years of “protracted syndrome” (aka neurotoxicity). The suffering trying to come off these drugs, albeit too rapidly as ordered by a medical doctor, was so severe that, for many years of this syndrome, I considered ending my life.

        No one said that the scans proved or disproved anything. It was made clear that “the results warranted further research.” I commented with the information solely because I knew of its existence and believed it relevant to the discussion. Dr. Lader called for funding to investigate further if I am not mistaken, but he was never granted the means to do so.

        • ‘Substance abuse’ is quite the misnomer for drug dependence, isn’t it? Doing so, a quite arbitrary distinction is being made between recreational pill popping and prescription pill popping. Most doctors don’t, but should, assist people in loosening their attachment to prescription chemicals, and, additionally, refrain from creating chemical dependencies among their clientele. The medical professional, obviously, needs to lessen it’s ties to the pharmaceutical industry, as those ties have corrupted current practice. When the length of the average lifespan is seriously challenged by current pharmaceutical usage, maybe it’s time for doctors to pay attention to the matter, and seek for less drastic means of relief.

        • Cole, I’m not anything like a neurologist, but I would have no reason to doubt that you have persistent symptoms of some kind of neurotoxicity, or equally debilitating neuroadaptive effect. I am very glad you did not end your own life, that we are able to learn from your experience, and that you shared that experience, and the study, with all of us. And I absolutely agree that it what you suspect is true– that no one followed up on the request for more research– that is a serious problem. Just googling about aimlessly, I do see one study from 1988 about midazolam in dogs, and there’s also a very interesting 2016 study in BMJ exploring the link between benzos and Alzheimer’s, though I think the sample size was small and the results were correlative rather than causative. Yes, I’d love to see more longitudinal studies that controlled for factors like cardiovascular disease, alcohol use, exercise, type of medication, etc.

      • You typed: “I do find that I find it almost unbearably frustrating …”. Couldn’t you have just simplified the sentence with “I find it almost unbearably frustrating …”? I guess referring to yourself twice in a sentence in this way could be seen as a form of “mindfulness”.

  8. Dear Dr Joanna,

    Thank you for this Article.

    My experience is that Prescribed Psychiatric drugs cause long term damage and disability. They also cause dependency, and this is why most people get into trouble, when they attempt to withdraw from Psychiatric drugs.

    The British Psychological Society maintain that they can help people suffering from “delusions” or “hallucinations” the same way as they help people suffering from “anxiety” or “depression”:- I suffered from dreadful “High Anxiety” when I discontinued powerful neuroleptics but was able to find a psychological means to cope – so the BPS are right.

    I think a solution might be to move on to the idea that there’s no such thing as “Schizophrenia” or “Bipolar”.

    • Also giving people these life long badges of shame (“schizophrenia” and “bipolar”) for having temporary break downs is the exact opposite of helpful. Along with the crippling drugs.

      But that’s assuming psychiatrists wanted us to lead healthy, productive, independent lives.

        • I believe you. So can Peter Breggin, RW, and countless others.

          But hard evidence is no match for propaganda like Big Pharma ads, TV shows, and catchy soundbites. People believe what is simple and easy to understand. If an idea is too complex they dismiss it as “paranoid conspiracy theory.” Why bother trying to understand the whole truth when little lies are easier to grasp?

          Sadly even credentials, research, and platforms aren’t convincing people. Probably because off this site many do not read books. They get all their info off TV shows, medical leaflets, local NAMI groups, and word of mouth from family doctors.

          Pretty sad.

  9. Fantastic article! Really enjoyed this, and agree with most of the conclusions, though I would have reached them by a different process of reasoning. I do not think that opiates, benzos, antipsychotics, mood stabilizers, and SSRIs have enough in common with each other that we can say we should have expected withdrawal or other effects from one drug based on our experience with others.

    I will never forget the reaction of a friend of mine who is an organic chemist when I showed him a diagram of the chemical structure of Prozac. “These are matchsticks,” he snarled– meaning that just by looking at the molecule, his expectation would be that it would have crude and unpredictable effects. Certainly, one can credibly argue that all psychotropic drugs are crude and unpredictable to some extent, and my own background in chemistry and neurobiology is quite weak, but it does seem like there are some differences in the side effect profiles of different classes of drugs.

    Benzos and opiates have catastrophic dangers for many classes of people, but seem to produce no problems for many, many others. Xanaz and Klonopin seem to be the most problematic benzos. With the opiates, it’s more of a crap-shoot as to which are most dangerous, though Oxycodone has obviously been one of the worst offenders.

    I think the evidence for opiate-induced hyeralgesia is very weak. All the studies I read seemed really agenda-driven, and I’ve never met someone who actually experienced these issues, but I have not worked with many chronic pain patients, only a handful. If this exists, my bet would be it only shows up over 10 ME per day.

    The reports I’ve heard about the side effects of antipsychotics and SSRIs (both as a clinician and just from friends), and the side effects I have observed with my own eyes for these two classes of medication, have always been far more alarming than what I’ve seen, or what’s been reported to me, about the others.

    I really don’t want to be a cheerleader for the other drugs, either. It just seems like the relative risk of antipsychotics are the highest and they are only effective for a very small subset of patients, which I would consider to be a SMALL subset of those who actually hallucinated and heard voices before being exposed to medication of any kind, e.g., ONLY those who are a clear danger to themselves and others– who wander into traffic, attempt to steal airplanes, etc. (Depakote did help my father in the last stages of dementia, when he did become, briefly, quite dangerous– his cognitive functioning improved and so did his mood, and I have no rational explanation for this.) Abilify seems to be the only “mood stabilizer” I’ve ever heard anything positive about– I’ve heard maybe five or six friends or clients tell me it helped them significantly, one or two who say it saved their lives.

    SSRIs seem to have a ludicrously bad cost-benefit ratio. I do not have a single suicidal patient who was never exposed to SSRIs, and all of them present very differently from suicidal people I met in the ’70s and early ’80s. I do not know a single person who ever told me it helped them significantly. They seem marginally effective for a very small percentage of patients, and extremely damaging to most. I cannot imagine why these drugs were ever approved.

    • “I think the evidence for opiate-induced hyeralgesia is very weak. All the studies I read seemed really agenda-driven, and I’ve never met someone who actually experienced these issues, but I have not worked with many chronic pain patients, only a handful. If this exists, my bet would be it only shows up over 10 ME per day.”

      Meanwhile, millions of people are suffering because of being yanked off their opioids or reduced to inadequate doses, and an alarming number of them are either turning to street drugs or killing themselves.
      https://www.washingtonpost.com/opinions/the-war-on-opioids-is-saving-lives-but-its-also-killing-people-like-me/2019/03/27/cea00af6-50c2-11e9-a3f7-78b7525a8d5f_story.html?utm_term=.3fe1f3258679

      Meanwhile, it’s legal for any adult to drink and smoke themselves to death while creating misery for everyone around them and costing society countless amounts of money. Yet it’s opioids that we need a war against? They ought to just be deregulated and available for any adult to purchase online or at a pharmacy. It’s fentanyl and herion laced with fentanyl that’s killing the vast majority of people, and they’re only turning to it because of lack of better options. It’s no mere coincidence that the more healthcare providers and the government has cracked down on opioid prescriptions, the higher the death toll has risen. From 5,000-9,000 a year back in the 2000’s — when doctors are accused of handing them out like candy at a parade — to being around or approaching the 80-90k a year that alcohol reliably kills each year.

  10. Catalyst, you know your stuff!

    I believe that, Neuroleptics (/”antipsychotics”) have withdrawal syndromes that lock people into long term psychiatric dependency and disability.

    I notice that most people that manage to come off Neuroleptics to recover do this in ways that are similar. Psychologist Dr Rufus May advises on drug withdrawal problems, but his advice is very similar to Psychiatrist Dr Pat Brackens.

    I wouldn’t see myself coming off these drugs without some means of dealing with the psychological effects of the withdrawal syndrome – because I would go mad.

    But what if the “Schizophrenic” is Homicidal??
    – I tried to kill myself several times on strong psychiatric drugs, but never after coming off them (or before I ever took them).

  11. just jumping back in here…

    a poster above did make an incredibly interesting point…if a psychiatrist realize that his or her profession is damaging to individuals, families, society as a whole (and the economy, btw)…

    why not do something else? because…while I do appreciate the body of work the ‘critical psychiatrists’ have put together, it does seem…

    they’re still in psychiatry, actively ‘diagnosing’ and drugging and/or shocking people. lower doses? hooray! wait a minute…how about no dose and some honesty?

    • Yes. To her credit Kelly Brogan is using her medical license and knowledge to undo the damage psychiatrists have done and helping unhappy women–often with nutritional deficiencies–to avoid the SSRI/SNRI gauntlet offered by psych ex-spurts.

      Get medical training in neurology, a legitimate branch of medicine that actually does deal with the brain. Or, if you actually like people, become a counselor like Peter Breggin and other old school “psychiatrists.”

      • Psychiatrists don’t become neurologists because they don’t seem mostly focused on actual brain diseases. They are focused on controlling behavior. The bad brain is merely the scapegoat of psychiatry, not their primary interest, because they know full well that the drugs don’t correct any deficiency or imbalance in the brain.

        We are smurfs, Gargamel is the corporate state, Azrael is the psychiatrist – always ready to pounce from the shadows and secret us away one by one…

  12. (In blunt terms) I believe Peter Breggin cures schizophrenia without drugs + Kelly Brogan works hard helping women avoid the SSRI trap.

    It’s not just about stopping medication. I don’t know how Peter Breggin works but he exudes humanity; and I like Kelly Brogans meditation (/spiritual) approach.

  13. I’m taking heart in what seems to be a new direction in Dr. Moncrieff’s work- that of speaking frankly of the damage SSRIs do and the gravity of SSRI withdrawal. I remember a youtube video of one Dr. Moncrieff’s talks a few years ago in which she was unfortunately not so well aware of these risks with regard to SSRIs. She spoke quite in depth about the risks and withdrawal for antipsychotics, but at that time did not believe that SSRIs presented comparably severe risks. It is gratifying to see this now, and I hope she will press on in this direction. Because quite frankly the problem is worse than any psychiatrists imagine.

  14. “It is astonishing that iatrogenic problems such as persistent diseases and dysfunctions induced by prescribed drugs have received so little attention from the research community.”

    I’m not astonished, I think it’s predictable. We’re talking about corruption, manipluation of information, and deceiving/confusing the public. That is status quo. Clear, honest, direct truth is the last thing I would expect anywhere in this arena. That would be a really nice and welcome change.

  15. Dr. Moncrieff’s focus is on the evidence, something that seems hard to question, but I prefer two other things that I believe are more important and more truly get to the heart of things. First, “evidence” is a scientific subject and sometimes legal and moral issues should take precedence. All bodily interventions used by psychiatrists are legally and morally bankrupt if they are given under conditions of direct or indirect force and not preceded by truthful information about potential risks and benefits. Bodily intrusions under such conditions is not the practice of medicine but the crimes off assault and battery, a type of rape. So from a legal and moral point of view, it is indefensible regardless of the so-called “evidence.”

    Next, rather than waiting for data to alert us to bodily harm from psychoactive drugs, it should be our PRESUMPTION. These drugs are specifically designed to enter the central nervous system, but none of them can target a specific abnormality since there are no abnormalities demonstrated for any emotional type of problem. It should be presumed that a substance put into the brain for no demonstrable abnormality has no reasonable chance of improving anything and every reasonable likelihood of doing damage. If the people who call themselves “neuroscientists” cannot recognize this, it just shows that despite being intelligent people they are simply more interested in defending their past behavior than really helping people.

    Dr. Moncrieff, surely one of the most important friends we have, writes, ” We should have been able to anticipate that SSRIs and other new drugs for depression and anxiety would produce withdrawal syndromes, although once again we were taken unawares.” I say “yes, we should have, and would have if we PRESUMED such things will happen, and not just with these drugs, but all psychoactive drugs given under force or duress, without genuine consent, and in the absence of any medical disorder..” This attitude will protect those who have a right to protection, and that means everybody, regardless of whether in some type of crisis or not. No evaluation necessary, thank you very much. Everybody is everybody.

    • I agree with you. The past talk that I am referring to I was in agreement with Dr. Moncrieff in all things except that it seemed she had not yet appreciated the seriousness of SSRI reaction and withdrawal, since at the time she framed it as mild compared to antipsychotics. I am glad to see this article now, since she is such an important ally.

    • Two excellent points, Lee. Morality and ethics are not scientific endeavors, and no amount of scientific experimentation can determine right from wrong – that’s an entirely human individual and social effort.

      I have also argued that the “null hypothesis” for these drugs should always be that they ARE dangerous, and the burden of proof should be on the company selling the drug to prove convincingly that they are not. If they can’t prove safety, we should assume dangerousness and act accordingly. If we did, medical care wouldn’t be the third leading cause of death in the USA today.

      • And another thank you for Dr. Coleman regarding the ethical piece. This circles back to madmom’s comment upthread that clinician’s should not prescribe any drug that they wouldn’t take themselves. (Or something to that effect.) There is a long tradition of self-experimentation in psychoactive drug development, some of it disastrous, some quite successful, some of it ethical, some not so much. (My own opinion is that Hofmann’s self experimentation and writing about psychedelics was far more principled than, say, Shulgin or Leary’s.)

        I remember clearly the first time I took Paxil, (prescribed for depression) and thinking, “This feels vaguely like the jittery, shivering feeling of the first 45 minutes of dirty LSD, but I can’t tell when it begins or ends, it never seems to go anywhere or lead to anything like insight or well being, and I have no idea what this feeling has to do with being depressed or not being depressed.” After taking it for about 12 days, I had an arousal disorder that lasted six or seven years. The terror that normal sexual function would never return (fortunately it did, I was one of the lucky ones) was nearly as bad as the side effects.

        As Rosalee notes, treatment without consent is a crime, and for good reason. It was really sobering for me to visit a patient in the hospital recently and discover that he/she was not even informed properly of what drugs he/she was taking in what dose, let alone how the drug was supposed to work or what the side effects were. The fact that this is routine practice for mild to moderate garden-variety suicidal ideation that might not have warranted treatment in the 1970s seems utterly depraved.

  16. I appreciate this article but there are many of us who never experienced withdrawal. Many of us are being diagnosed with chronic conditions such as dementia, medication induced Neurocognitive Disorder, hyponatremia, Chronic Fatigue Syndrome, Fibro, orthostatic hypotension, neuropathy and others. Psych meds are known to cause mitochondrial Damage. I included some studies.

    Many of us are looking for ways to communicate this to the public but they are only found in independent studies and really unknown to the masses.

    https://www.madinamerica.com/2012/09/things-your-doctor-should-tell-you-about-antidepressants/

    http://psychrights.org/Research/Digest/NLPs/DrugsCauseMitochondrialDamage.pdf

    https://www.hindawi.com/journals/bn/2018/5315098/

  17. Thanks for this article Dr. Moncrieff and the conclusion:
    “Doctors must understand and explain that drugs change the brain, and other parts of the body, in ways that we do not fully understand, that are almost always harmful to some degree, and that may be irreversible.”

  18. Where is the research on what happens to a person after being given massive polydoses of antipsychotics? I was on 900 of Seroquel, 20 of Abilify, and 6 of Risperdal, simultaneously, and also concurrent with 600 of Lamictal, 300 of Topamax, and a third anticonvulsant, Trileptal. All at once.

    I believe I have permanent insomnia, eight years of resulting exhaustion now with no improvement, as a result of all those anti-p drugs. Nothing helps except to get my hands on some drugs, which gives me partial relief.

    I am scared to death to see a sleep doc because of their tendency to misdiagnose and worsen what is already a bad situation.