Fear and Belief in “Chemical Imbalance” Prevent People from Coming Off Antidepressants

Researchers interviewed people who were given medical advice to discontinue antidepressants.

Peter Simons
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In a new study, researchers interviewed people who were given medical advice to discontinue antidepressants. The participants’ use of antidepressants was deemed “not indicated” based on clinical practice guidelines. They had no current mental health diagnoses, no history of recurring mental health problems, and had been taking antidepressants longer-term than guidelines suggest (longer than nine months). Despite receiving this advice to discontinue, more than half of the participants refused to stop taking the drug—and researchers found two primary reasons why.

The research was led by Rhona Eveleigh and Peter Lucassen at Radboud University, the Netherlands. The study was published in Therapeutic Advances in Psychopharmacology.

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According to the researchers, about five out of every six users of antidepressants do not benefit. Thus, the majority of people taking antidepressants are exposed to the potential harms of the drug unnecessarily. The evidence around long-term use is sparse (most drugs receive FDA approval based on short-term studies), but studies have demonstrated that long-term use may be unhelpful or even cause more harm than good.

Clinical practice guidelines reflect this research. Generally, the advice presented in guidelines is to consider discontinuing antidepressant use after several months (the exact timeframe varies by guideline), if the indicated symptoms have decreased. Of course, many people are taking antidepressants that are prescribed off-label in a manner that does not follow guidelines at all, and discontinuation may be an option in such cases as well. 

In their interviews, the researchers identified two significant barriers to discontinuation. The first was fear: fear that if participants ever stopped taking antidepressants, they would experience levels of depression with which they might be unable to cope.

“Fear (of recurrence, relapse, or to disturb the equilibrium) was the most prominent barrier, and prior attempts fuelled these anticipations.”

According to the researchers, the best solution to that fear was clear explanation and guidance from the prescribing doctor: framing the antidepressant use as temporary at the initiation of treatment, as well as a clear understanding of the withdrawal process for discontinuation. 

The second barrier to being able to follow medical advice around discontinuation was a belief in the debunked serotonin deficiency theory: the notion that antidepressants correct a chemical imbalance. In their interviews, the researchers found that this mistaken belief was linked to the idea that the participants had a life-long illness and would require antidepressants indefinitely. 

“Serotonin deficiency as an explanation for antidepressant effectiveness promotes life-long use and hinders discontinuation of antidepressant treatment.”

For instance, here are the words of two different participants who “rejected advice and did not discontinue” the drug:

“I just need it. For me, this isn’t a psychological illness, it’s physical. And my body isn’t able to make enough serotonin, so I take the pill to supply it.”

“She (the GP) told me, you should see it like you have a deficiency in your brain, you miss a certain substance and the medicine supplies it. She told me it’s just like someone with diabetes who needs insulin for the rest of their life. Well, I kind of believe that, so never questioned my use since.”

According to the researchers, explaining emotional distress biologically “seems to backfire, making it difficult to persuade the patient to discontinue the drug.”

However, other doctors had clearly described the use of antidepressants differently. Another participant said: “My GP made it very clear, it (the antidepressant) is only a temporary solution, it will help, but the problem lies elsewhere.”

It seems that the way the prescribing doctor framed the use of antidepressants played a significant role in whether the person tried to follow the advice to discontinue or not. 

Additionally, when the doctor was seen as a helpful figure who took the patient’s concerns seriously and would assist with discontinuation, patients were able to see that as “a safety net” and begin the process of tapering off the drug. 

The researchers write that doctors need to be aware of patients’ fears around discontinuation, as it may prevent them from acting on medical advice. They also suggest that doctors keep abreast of new methods for tapering antidepressants to minimize withdrawal symptoms.

 

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Eveleigh, R., Speckens, A., van Weel, C., Voshaar, R. O., & Lucassen, P. (2019). Patients’ attitudes to discontinuing not-indicated long-term antidepressant use: barriers and facilitators. Therapeutic Advances in Psychopharmacology, 9, 1-9. https://doi.org/10.1177/2045125319872344 (Link)

11 COMMENTS

  1. “They had no current mental health diagnoses, no history of recurring mental health problems, and had been taking antidepressants longer-term than guidelines suggest (longer than nine months).”

    We acknowledge the psychological toll of a belief in the “chemical imbalance” narrative.

    But we don’t think to step back and analyse the narrative of “mental health diagnosis” or “recurring mental health problems”?

    It’s a worry.

    What do we mean when we say “mental health problems” – what do we actually mean?

    I think by now there has been enough discussion for most people to realise we don’t actually mean anything. Other than that a person was sad, worried, stressed, grieving, exhausted, crashed, overwhelmed, abused, oppressed by the state of the world or a host of other things, unlimited in their scope that have been skilfully torn out of their context in life and renamed “mental health problems”.

    Sometimes, we just mean diversity. A person sees a vision or hears a voice and even if they aren’t distressed by it – we scream “serious mental illness”.

    There have been articles & analysis on this ad nauseam by now, analysing the situation every which way including the marketing side of things eg.
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1122833/

    It’s only a google search away to find copy written by marketing firms gleefully explaining how every opportunity to “raise awareness” is an opportunity to sell more product – even if no drug or ‘condition’ is specifically named.

    So we know by now that “mental health” and “mental health awareness” were genius use of marketing to sell us sickness. To rival the ‘litterbug’ campaign that sold us garbage, literally.
    https://www.motherjones.com/politics/2006/05/origins-anti-litter-campaigns/

    No that doesn’t mean suffering isn’t real or diverse. Just that we have always had suffering in life – we just used to call it life.

    We’ve always had prejudice in life too – just that we used to call it prejudice – or just be prejudiced (usually more likely). Prejudice has always been an arbitrary, fickle thing that really seems to depend on little more than who has the microphone & gets most heard.

    So with that in mind – why are we spreading the narrative of ‘mental health’ a narrative that was designed, quite deliberately to get us to be prejudiced against ourselves and others so we would purchase drugs and hand all of our decisions over to guilds who controlled the narrative?

    When we know that the narrative gets lodged because we spread it – why would we keep paying tribute to that ritual – when just the act of thinking for a few moments how to phrase what we say could help us bring trouble back into life – and out of the arena of ‘health conditions’

    Is there any good reason why we wouldn’t want to do a thing like that?

    • I was only on an antidepressant for one month, prior to my doctor taking me off it cold turkey, since it didn’t help me quit smoking. I had the antidepressant discontinuation syndrome flu like symptoms for over a year, all misdiagnosed and mistreated. And I didn’t even get the bizarre brain zaps and odd sexual effects until over a year later, likely prompted by the horror of 9/11/2001 event.

      But the bottom line is yes, even one month on the antidepressants can result in years and years of antidepressant discontinuation syndrome symptoms. I still have the brain zaps, 18 years later.

  2. I was very angry when I found out I had been lied to. For years I lived in terror of not getting my “meds” refilled or having them suddenly “stop working” as the NAMI leaders and babysitters at the mental center repeatedly warned us.

    Totally dependent on the drugs and all the “sane” people. I knew I was powerless to change my life or make any rational choices. Chalk it up to “good insight.”

    They told me the “mentally ill” are helpless and stupid even on their “meds.” But evil when taken off.

    You know what’s really evil?
    Lying to trick someone into taking addictive, mind altering drugs is pretty darn evil. Worse than anything Walter White ever tried.

    I read a post on Pete Earley’s blog where the Not-My-Father-of-the-Year said it was a no big deal lying about it. Apparently all the high ranking NAMI mommies are in on the hoax.

    I have nothing good to say about that organization now. Though letting my young friend die from a neuroleptic grand mal seizure should have clued me in.

  3. The “chemical imbalance” lie, the lie that will never die. Let’s hope the doctors stop lying to their patients, including claiming all the BS DSM disorders are “life long, incurable, genetic” diseases, when the DSM disorders are not even real diseases. Thanks for trying to proper re-educate the doctors.

    Does Dr. Double still need more re-education?

  4. I’m curious about the guidelines that say to use the antidepressants for nine months—–seems very arbitrary. Is it no longer than nine months or up to nine months? What is the source for this information?

    I agree that most people are very afraid to discontinue antidepressants—and I know many who have been taking them for 10-25 years. I just wonder what that stuff is doing to them. Some seem fine, others struggle with depression despite meds.

    • The reason it seems arbitrary is because it IS arbitrary. The research on “antidepressants” rarely extends beyond 8 weeks. No one knows how long one would continue to “benefit” from taking these drugs. Or if a particular person would benefit at all. Or actually what “benefit” really means in this case.

  5. Great concise article as always!

    I think it’s worth adding that the fear of withdrawal effects and/or the experience of withdrawal effects are a major reason why people don’t want to come off.

    I also want to add that I have experienced the same things you quoted from other patents as far as it being a “chemical imbalance.” I will say that part of what they (the psychiatrists/doctors) are saying is true. I think it is generally agreed upon that mental health issues arise and correspond to a real physical brain etiology. So let’s make sure that we are being honest and saying there is a physical “problem” but it’s being very over simplified.

    • Do you know of any evidence that any of these “disorders” are physical problems? I don’t. For sure, physiology can be involved, including things like sleep, diet, exercise, drug intake, physical pain, etc. And there ARE physiological conditions that can cause mental/emotional effects (like Lyme Disease). But so far as I know, there is no proof that any “mental illness” is consistently CAUSED by a physiological problem. Remember that these entities are defined by committees voting, not by any kind of scientific process. How would they even know the cause if they are defined by a list of behaviors and feelings?