Researchers: Antidepressant Withdrawal, Not “Discontinuation Syndrome”

Researchers suggest that the pharmaceutical industry had a vested interest in using the term “discontinuation” in order to hide the severity of physical dependence and withdrawal reactions many people experience from antidepressants.

Peter Simons
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The term “discontinuation syndrome” is deliberately misleading, according to researchers writing in The British Journal of Psychiatry. Elia Abi-Jaoude and Ivana Massabki suggest that the term is just a euphemism for the more accurate term “withdrawal.” They write that the term “discontinuation syndrome” was coined with pharmaceutical industry support to downplay and discount the testimony of people who experienced adverse effects after stopping SSRI antidepressants.

“The term discontinuation syndrome, which appears to have been established and publicized with the support of the pharmaceutical industries to minimize patient concerns regarding the use of SSRI medications, is misleading and should be abandoned in favor of the more appropriate term SSRI withdrawal,” they write.

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A recent update to the UK’s guidelines acknowledged the potential for severe, long-lasting withdrawal from antidepressant drugs. This came after an article last year in BMJ, excoriating guidelines for minimizing withdrawal symptoms. In that article, researchers wrote that patients were being misdiagnosed as having a relapse of depression when instead, they were experiencing withdrawal from SSRIs.

Another study found that more than half of people taking antidepressants experienced withdrawal symptoms—and about 25% rated those symptoms as “severe.” Yet another study found that, on average, SSRI withdrawal lasted 90.5 weeks, while SNRI (another class of antidepressants) withdrawal lasted 50.8 weeks.

In their article, Massabki and Abi-Jaoude examine the history of the term “discontinuation syndrome” in peer-reviewed scholarly papers. Before 1997, the term was used only once. However, in 1997, a supplement issue of the Journal of Clinical Psychiatry used the term—setting off a chain reaction that resulted in 12 uses of the term in that year alone. That issue was sponsored by pharmaceutical firm Eli Lilly (makers of Prozac, Cymbalta, and Zyprexa). It featured a definition of “discontinuation syndrome” that was no different from withdrawal and could be applied to the harmful effects of stopping any drug.

The next big spike in usage occurred in 2006 with the publication of a second supplement issue in the same journal—this one sponsored by pharmaceutical firm Wyeth (makers of Effexor). In that issue, the writers suggested that researchers should stop using the term “withdrawal” and use the term “discontinuation” instead. They argued that the term “withdrawal” was worrisome to patients who were worried about becoming physically dependent on antidepressants. The writers also argued that “discontinuation syndrome” was different from withdrawal—but again, their definition did not distinguish between the two. The 2006 supplement included the following list of antidepressant withdrawal symptoms which they used to define discontinuation syndrome:

“Neurosensory (e.g., vertigo, paresthesias, shock-like reactions, myalgia, other neuralgia); neuromotor (e.g., tremor, myoclonus, ataxia, visual changes); gastrointestinal (e.g., nausea, vomiting, diarrhea, anorexia); neuropsychiatric (e.g., anxiety, depressed mood, intensification of suicidal ideation, irritability, impulsiveness); vasomotor (e.g., diaphoresis, flushing); and other neurologic (e.g., insomnia, vivid dreaming, asthenia/fatigue, chills).”

According to Massabki and Abi-Jaoude, “the symptoms described are typical of patients experiencing withdrawal and indicate the various ways in which patients can become dependent upon their SSRIs.” In fact, another recent review found that out of 37 out of 42 withdrawal symptoms occurred for both benzodiazepines and SSRIs. So why is the same experience called “withdrawal” for benzodiazepines, but “discontinuation syndrome” for SSRIs?

Massabki and Abi-Jaoude write that the answer lies in the subtle way that “discontinuation syndrome” sanitizes the difficulty people have when they attempt to stop their SSRI use. The term “discontinuation” is misleading, they write, because even a gradual taper can result in withdrawal symptoms—full discontinuation is not required. And the term “syndrome” meaning “illness” is a way of hiding the fact that the harms are due to the effect of the drug itself.

The researchers conclude that the use of “withdrawal” terminology promotes better informed consent. When patients know the risks and benefits of the drug they’re offered, they have more autonomy over their choices. Additionally, if they acknowledge the dangers of withdrawal, medical professionals may be more able to help people who want to lower their dose or stop using SSRIs altogether.

“Overt acknowledgment that SSRI use can result in dependence and withdrawal SSRI discontinuation syndrome or withdrawal allows patients to be truly informed in their decisions, and helps inform strategies for safe tapering of these widely prescribed drugs.”

 

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Massabki, I., & Abi-Jaoude, E. (2020). Selective serotonin reuptake inhibitor “discontinuation syndrome” or withdrawal. The British Journal of Psychiatry, 1–4. DOI:10.1192/bjp.2019.269 (Link)

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Peter Simons
MIA Research News Team: Peter Simons was a published researcher, on track to becoming a psychologist, when he decided to leave that world behind him due to creative differences. As a science writer for Mad in America, he tries to provide the layperson with a view into the sometimes inscrutable world of psychiatric research. As an editor for blogs and personal stories at Mad in America, he prizes the accounts of those with lived experience of the psychiatric system and hopes to create alternatives to the mainstream assumptions of the biomedical model.

19 COMMENTS

  1. Verbal gymnastics from a bunch of frauds and slanderers? Who would have thought. I wonder where it originated though, our Minister for Health here tells me in a letter that he prefers the terms “referral” and “detention” rather than the factual terms “torture” and “kidnapping” for what is being done by his charges at our hospitals. This despite having the documented proof placed on his desk. Perhaps he is under the influence of some of these “medications” not “drugs” his buddies are peddling to a captive audience?

    Quite a clever chap is our Minister. Likes to suggest that anyone who has been subjected to violations of their human rights requires medical treatment from the very same people who violate their human rights. A dog whistle slanderer he is.

  2. Well, it would be a discontinuation syndrome if withdrawal from the usual suspect illegal drugs were also grouped into this definition. It would be fairly meaningless, as the correct treatments would differ with each category of drugs within this larger group, but then, who said that psychiatric definitions had to be meaningful in the first place?

  3. As always psychiatry needs to lie.
    The word “syndrome” is one of those lies. It’s intention is to make
    something factual sound as if some mysterious and isolated thing is occurring
    for which they have no explanation.
    I doubt very much that a shrink would even talk about the “discontinuation syndrome”
    or the body damage before he writes the script.
    And for those who think patients opt and want drugs, I can vouch
    that in fact, people are OFFERED these drugs by even enthusiastic ER staff.
    Drug pushers, illness pushers.

    • Yes, they are disingenuous drug pushers, illness and addiction creators. My mom had hip replacement surgery yesterday, all went well, which is good. After the surgery, my mom was taken to her room. She wasn’t in much pain, which was good. But the nurse couldn’t wait to get her on pain killers.

      I mentioned that unless mom was in a lot of pain, we should steer clear of the opioids. The nurse agrees, and gives mom some Tylenol. Then says she’s going to put an “anti-inflammatory,” tramadol, into her IV.

      When I got home, a friend called to see how mom was doing. I said good, but we get chatting, and she warns me to make sure mom is not put on tramadol.

      So I googled it, and oh yes! I know exactly what tramadol is, it’s Ultram. The “dirty opioid” I was given, that in part, led to my “bipolar” misdiagnosis. Calling opioids by many names, lying and claiming opioids are “anti-inflammatories.” Claiming withdrawal is a “discontinuation syndrome.” It’s all lies.

      Not to mention it says clearly in drugs.com: “You should not take tramadol … if you have … recently used alcohol, sedatives, tranquilizers, or narcotic medications;” Gosh, do they sedate and/or tranquilize people prior to surgeries, of course they do.

      Now I don’t think mom will become addicted in one day, but I don’t appreciate doctors or nurses lying. And absolutely, we are dealing with systemic lies from the top, which do trickle down to systemic lies by doctors and nurses to all their patients. And that is just wrong.

      • Actually it’s a “dirty opioid” because – it’s a TINY amount that hits the opiate receptors, but the LARGEST portion of the tablet is an SSRI.

        Look out also for “tapentadol” which is an SNRI / opiate.

        They favour giving these because of the “opioid crisis” because it is not listed as a drug of dependance.

        These are evil, evil drugs.

  4. It “seems” it was coined with the “support” of the pharm industry.
    Now psychiatrists want to blame pharm? Least it’s a start 🙂
    So who is in charge of psych terminology? Since the drug makers are not actually treating the patients.
    They were not responsible for the DSM, nor do they write the actual script…..the one
    that causes withdrawal from psychiatry.

    Look at them busy playing amongst each other. Just to keep the MI idea going, constantly trying to get people off the scent/stink

    • “Discontinuation syndrome” was obviously an intentional euphemism for withdrawal. It was invented to keep a distinction from street drugs, as no one wanted the similarities between the two to be noticed or talked about. Another example of the disingenuousness of the psychiatric industry.

      • Yes Steve,
        Also “discontinuation”, sounds like a voluntary choice of “discontinuing treatment”,
        It sounds a bit “non-compliant”.

        “well if you had just stayed on the drugs I advised as per my professional opinion, you would not be dealing with this discontinuation syndrome”.

        Know what? I think some people come on here to lurk, to see what we know on an intuitive level and then go into a room to discuss what terminology they can create that could invalidate people.
        I imagine they use a thesaurus and dictionary.

  5. If informed consent is the goal, the withdrawal symptom list should also include the sexual “side effects” of the SSRIs and SNRIs.

    And there are millions of Americans who have had the adverse and withdrawal effects of the antidepressants misdiagnosed as “bipolar,” too.

    But, no doubt such misdiagnoses will only increase, since the DSM-IV-TR disclaimer, pointing out the impropriety of such malpractice, was taken out of the DSM5.

    And, as one who’s had the brain zaps for 19 years and counting. I’m quite certain the withdrawal effects may sometimes result in permanent harm, not just short run withdrawal effects.

    I agree, the truth about the psych drugs needs to shared with the doctors, and the public.

    Especially since the doctors are seemingly now all claiming to be ignorant of all the common adverse and withdrawal effects of the antidepressants.

    That’s what I found was the truth two decades ago, as well. However, at that time the doctors, psychiatrists, and psychologists were fraudulently claiming to “know everything about the meds.”

    Yes, we all need truth.

  6. I suggest we change it to “antidepressant retirement syndrome” …

    Most prescribers, if you ask them, wont even be able to distinguish abstinence from withdrawal.

    Withdrawal is a much longer process and has to do with neurotransmitter up- and down-regulation caused by the long-term use of these types of drugs.

    Withdrawal from the dirty drugs they call atypicals is a hellish process because of the myriad brain adaptations these drugs provoke …

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