Antidepressant Withdrawal Misdiagnosed as Functional Disorder

Adverse physiological symptoms of antidepressant withdrawal are regularly mistaken to be other problems to the detriment of the patient.

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In a new article in the Journal of Critical Psychology, Counselling, and Psychotherapy, psychotherapist Marion Brown and service user and campaigner Stevie Lewis present the dangers of misdiagnosing antidepressant withdrawal as other conditions. They note that prescribers often mistake patients’ experience of withdrawing from antidepressants as Medically Unexplained Symptoms (MUS) or Functional Neurological Disorders (FNDs).

The authors have collaborated to petition the Scottish and Welsh governments, demanding attention be given to the problems created by antidepressant dependence and other adverse effects.

“The impact of prescribed drug withdrawal being swept under the carpet for the past 20 years has had profound consequences for both the UK National Health Service (NHS) and individual patients,” they write. “For individuals, they have had to live with the ramifications of being told that they are more ill than they thought they were. They are told they have ‘relapsed’, they have Medically Unexplained Symptoms (MUS), Functional Neurological Disorders (FND), Bodily Distress Syndrome (BDS), chronic fatigue, irritable bowel, and a range of other diagnoses.”

For decades antidepressants have been considered the first line of treatment for depression and other psychological issues. There is growing evidence that antidepressants may be less effective and have more risks than originally thought. Critics have noted that these concerns emerged as soon as antidepressants were introduced but were effectively silenced. More recently, withdrawal was repackaged by the pharmaceutical industry as “discontinuation syndrome” to make it more palatable.

Recent research has found that antidepressant withdrawal can be long-lasting and severe, contrary to popular belief. As a result, top researchers and organizations have begun to acknowledge the dangers of antidepressant withdrawal and make changes to their guidelines.

Brown and Lewis’ article points to the harms of misdiagnosing patients who are experiencing withdrawal with MUS or FNDs. Brown has witnessed this happening to her clients, and Lewis experienced these adverse effects first-hand.

In the opening statement of her 2017 petition, Brown presented evidence to the Scottish government where she summarized her clients’ experience. She represented clients whose experience with benzodiazepine and antidepressant withdrawal was often disregarded and even belittled by prescribers. She further noted that while clinical trials of drugs are short-term, they are often prescribed long-term, even indefinitely.

Often online self-help groups are the only source of support, empathy, and advice for struggling patients. When patients seek help, doctors often consider them gullible or troublesome and sometimes diagnose them with a personality disorder or MUS and FNDs.

In her petition to the Welsh government, Lewis stated that the NHS staff is being trained and educated to look at what are often withdrawal symptoms as MUS or Bodily Distress Syndrome (BDS). As a result, the actual physiological effects of changing, starting, and discontinuing antidepressants are completely ignored.

The authors note that this physiological dependence often creates problems in the fight/flight/freeze response, leading to excruciating akathisia–a desire to run away from one’s own body.

The petition included stories from over a hundred patients. These stories and other evidence were also covered in a recent research paper co-authored with other researchers. This paper traced similar misdiagnosis of drug-related symptoms as MUS, FNDs, or relapse.

They noted that there were glaring holes in the system, that prescribers needed to be better educated, alternate non-pharmacological treatments deserved more attention, and patient feedback had to be taken seriously. They write:

“In this sample, 25% of patients with antidepressant withdrawal presenting to their GP were diagnosed with MUS, a ‘functional neurological disorder’ or ‘chronic fatigue syndrome.’ Many of the signs and symptoms associated with these medically unexplained disorders, captured in the often-used PHQ-15 (Patient Health Questionnaire Somatic Symptom Severity Scale –M.B. & S.L.), overlap with the symptoms of antidepressant withdrawal.”

The authors point out that many discontinuation symptoms (dizziness, racing heart, nausea, etc.) are translated by assessment tools that portray them as medically unexplained symptoms to clinicians.

Lewis noted that Rosendal’s paper on medically unexplained symptoms and Bodily Distress Syndrome (BDS) comes closest to describing her own experience of antidepressant withdrawal. Rosendal clustered the symptoms into four categories: breathlessness, heart palpitations, diarrhea, nausea, muscular pains, weakness, numbing, fatigue, memory impairment, and concentration problems. Given the overwhelming similarities, Lewis concludes that:

“These ‘medically unexplained/functional/somatic symptoms’ and ‘bodily distress’ etc., are connected to the wide-ranging serotonergic effects of antidepressants and how the body tries to adapt (via all-important homeostasis) to any such changes.”

The authors note that despite evidence of antidepressants causing neurological problems, there is little to no recognition from neurologists that drugs meant to affect the central nervous system could be the reason for its dysfunction. Thus, neurologists are still chasing FNDs instead of paying attention to the withdrawal effects of antidepressants, which can include neurological impairment.

They conclude by noting that these withdrawal effects are known, but prescribers have turned a blind eye to them and are instead mistaking them for MUSs, BDS, and FNDs. This could cost the NHS a lot of money, but more importantly, it costs patients their health and well-being.

 

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Brown, M. Lewis, S. (2021). The Patient Voice: Antidepressant Withdrawal, Medically Unexplained Symptoms, and Functional Neurological Disorders. Journal of Critical Psychology, Counselling, and Psychotherapy, 20 (4), 14-20. (Link)

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15 COMMENTS

  2. When a psychiatrists says you have a chemical imbalance and an illness it is a euphemism. What they really mean is, “I want status, money and won’t admit the harm I cause so I am going to give you drugs that cause a chemical imbalance, damage the body and brain and of which give you an illness.” It is the sunk loss fallacy. In order to stop harming hundreds of millions of people they’d have to admit their whole adult life consisted of lying and hurting people. In America alone psych drugs kill a rough estimated 500,000 people a year (neuroleptic increase death rates by 200-300%, serotonin drugs by 50%, stimulants by 75% and bensons by 60%).

    https://pubmed.ncbi.nlm.nih.gov/28903117/
    (SSRI increase mortality by 49%, stimulants by 75%, older lesser used drugs are less deadly than then more commonly used newer ones)

    https://pubmed.ncbi.nlm.nih.gov/16449697/
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3888674/pdf/CPN2013-247486.pdf
    (Neuroleptic increase mortality by 200-300% in all groups)

    https://www.bmj.com/content/358/bmj.j2941
    (Bensons increase mortality rates by 9% over similar people who take serotonin drugs)

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  3. This article goes to the heart of all that is so disgustingly wrong with the mental health system/industry … the education of medical/mental health practitioners which discount lived experience [and here I’m speaking about lived experience which actually *contradicts* the mental health/illness narrative, not those select few who have been accepted by the system because their story backs up diagnosis/misdiagnosis and leaves out all the shadowy, scary bits re. adverse effects of the meds etc, of which, in Australia at least, there are many such lived experience practitioners]; the sidelining and negating of alternative views and alternative practices which actually question the dominant paradigm right at its basis – i.e. is mental illness real or is it possibly a social construct? – and which, more importantly, actually work to allow a person to work through their experiences and come out the other side; the blind acceptance and lack of intelligence of practitioners who refuse to do their own research in these matters and therefore do endless amounts of harm to those who are unlucky enough to walk into a doctor’s office with grief or sadness or frustration or high levels of stress that they’re momentarily incapable of dealing with and walk out with a diagnosis and a prescription or a referral to someone else who is likely to interpret their symptoms via the lens of the DSM and oops, there goes your life, welcome to that endlessssssss treadmill of the mental health system.

    and yes, some good is done. sometimes. but that’s not good enough, not when the consequences for misdiagnoses/meds are so life and soul-destroying. it’s nowhere *near* good enough. and accountability and responsibility needs to be taken and heads should roll.

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  5. ‘They noted that there were glaring holes in the system, that prescribers needed to be better educated, alternate non-pharmacological treatments deserved more attention, and patient feedback had to be taken seriously.’ Marion Brown campaigns tirelessly, along with others, for her knowledge to be recognised, with the aim of bringing about improvements in medical practice. Others are helping to disseminate that knowledge widely. Some medical professionals in Scotland are at risk of having trust in them justifiably eroded: and to a great extent.

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    • And comments like that have been made for decades. Yet, no one fills the holes, the prescribers are not better educated, non-pharmacological treatments are not given attention, and patient feedback is minimized or ignored. What could possibly occur that would change this?

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      • yes. you’re absolutely right. comments like that have been made for decades. and nothing changes. the only thing that will change what happens, i believe, is if individual doctors, mental health practitioners, are sued for malpractice. preferably for gazillions. and the only ray of hope i can see in regard to that happening, are the ruinous law suits that have been brought against the pharmaceutical companies in regard to the opioid epidemic.

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        • I think you’re right. It is driven by profits, so making it no longer profitable to drug people for ostensible “mental illnesses” is the answer. But drug companies can apparently afford the fines, so going after the prescribing doctors or those creating the “practice guidelines” seems the most likely to be effective.

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        • The opioid crisis is very similar to psych drugs. The drug companies hid negative data, they lied about the drugs being addicting, they paid doctors to push the drugs, their “effectiveness” came exclusively from short term data, people who pointed out negative effects were sidelined/insulted, the drugs were given out like Halloween candy, non drug treatments were ignored, and so on. A major difference is that psych drugs kill more people.

          It might be effective when telling people about how psych drugs are a massive net harm to remind them of how the opioid madness went.

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  6. “Adverse physiological symptoms of antidepressant withdrawal are regularly mistaken to be other problems to the detriment of the patient.”

    Don’t forget about the millions and millions of us who had the common symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar.” All, apparently, because the “mental health” workers weren’t intelligent enough to even read their DSM-IV-TR, which clearly states:

    “Note: Manic-like episodes that are clearly caused by somatic antidepressant treatment (e.g., medication, electroconvulsive therapy, light therapy) should not count toward a diagnosis of Bipolar I Disorder.”

    And due to all that systemic malpractice, brilliantly pointed out in Whitaker’s book “Anatomy of an Epidemic.” The lovely APA psychiatrists took that disclaimer OUT of their DSM5, rather than adding the ADHD drugs to that disclaimer, ensuring even more systemic iatrogenic harm of patients.

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      • That’s the opposite of informed consent, but it has been my experience that psychologists and psychiatrists do nothing but blatantly lie to people.

        However, now that I expect this from them. When I’m forced to deal with an unsolicited psychologist, who incorrectly assumes things about me – like I would want him to take control of all my money, and steal all profits from my work – as one unsolicited psychologist assumed not long ago.

        At least I was able to prevent him from making an ass out of me, by saying no. Albeit, I had to say no, way too many times. But I was not able to prevent him from making an ass out of himself, despite having told him that I did not want him to steal from me, prior to him even handing over his classic thievery contract. The arrogance, and outright criminality, of the psychologists and psychiatrists is truly staggering.

        I do understand it’s a shame for them, that their DSM “bible” has been debunked as “invalid.” But I hope they may come to grips with reality, at some point. Especially since maintaining a “status quo,” where one’s industry is killing “8 million” innocent people every year, is not a “status quo” that should be maintained.

        https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2013/transforming-diagnosis.shtml
        https://www.nimh.nih.gov/about/directors/thomas-insel/blog/2015/mortality-and-mental-disorders.shtml

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