Four Essential Studies on Antidepressant Withdrawal Every Prescriber Must Read

A researcher and service user Stevie Lewis recounts her own experience with antidepressant withdrawal and what she wishes her doctors knew.

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In a new article published in the British Journal of General Practice, researcher and campaigner Stevie Lewis writes about her experience with antidepressant withdrawal. She points to four significant studies that she wishes her doctors had read before prescribing her antidepressants in 1996. She goes on to summarize the findings of these important studies.

Antidepressant withdrawal, which had long been denied and ignored by the psychiatric community, is at the forefront of the conversation now. Numerous official medical bodies and even prominent psychiatrists have pointed to the adverse and long-lasting effects that can occur when discontinuing antidepressants.

This has exposed biased methodologies behind much of the extant antidepressant research, with drug companies often actively suppressing placebo response rates. It has also raised serious doubts about the chemical imbalance hypothesis, so much so that many psychiatrists are now beginning to divorce themselves from it. Service user movements and voices are responsible for drawing attention to this issue and demanding changes. This article adds to those concerns by undertaking an academic analysis through a first-person narrative.

Lewis writes that while in 1996 there was already some research around withdrawal effects of antidepressants, campaigns such as Defeat Depression had successfully managed to portray it as a chemical imbalance problem. As a result, antidepressants were claimed to be safe, effective, and non-habit-forming.

She then notes that today her experience of repeatedly trying to get off antidepressants and being hounded by severe withdrawal symptoms is neither uncommon nor unknown. Moreover, the hypothesis that antidepressants can cause structural and chemical changes in the brain and result in drug dependence is gaining widespread acceptance. For example, The Royal College of Psychiatry recently released a statement about their severe and long-lasting dependence.

Lewis provides an overview of four important studies that are essential reading for general practitioners who want to update and inform themselves of recent findings on antidepressant withdrawal. There are many reasons antidepressants are overprescribed: industry corruption, biased methodology, overprescription by general practitioners, etc. Lewis’ suggestions to general practitioners are thus of particular importance here.

The first paper is a 2019 systematic literature review by Davies and Read, which identified and analyzed 24 studies. It found that:

“More than half (56%) of people who attempt to come off antidepressants experience withdrawal effects, with nearly half (46%) of people experiencing withdrawal effects describing them as severe. For patients, it is not uncommon for the withdrawal effects to last for several weeks or months.”

Lewis writes that the NIMH has for decades underplayed how common antidepressant withdrawal is but recently has admitted to its severity and long-lasting nature.

The second important piece of literature is a 2020 paper by Guy, Brown, Lewis, and Horowitz that details the first-person service user experience of mistaking psychotropic drug withdrawal for relapse. In other words, what is actually withdrawal from drugs is wrongly assumed to be the patient relapsing into the original underlying condition (such as depression) or the emergence of a new one.

The experience of 158 responders was analyzed for themes, which were used for petitions forwarded to the Scottish and Welsh parliaments. The authors found 8 separate points where doctors mistook psychotropic drug withdrawal for something else; they also lacked knowledge on tapering techniques. In addition, patients were often given inadequate information about withdrawal risks.

The next paper summarized by Lewis is a 2019 article by Horowitz and Taylor concerning ways to taper off antidepressants. Lewis considers this to be the most important article, given that if her prescribers knew about it, it might have eased her own ordeal.

Using PET scans, the authors conclude that tapering should be slow and hyperbolic (smaller and smaller reduction each time) to doses that are vastly smaller than what is considered minimal dosage. This is essential to reducing withdrawal effects. This article helps differentiate between withdrawal (which occurs in days, responds to antidepressants, and can physiologically and psychologically appear different from original symptoms) and relapse. Despite these differences, sometimes the original symptoms and withdrawal can look the same, complicating matters further.

Given the dearth of systemic services that help people withdraw from psychotropics or even provide relevant and updated information, the service-user movement has filled in the void. Social media support groups are an integral part of this. Thus, the last paper suggested by Lewis is a 2021 study by Framer on Facebook support groups for antidepressant withdrawal.

Framer is a service user and struggled with antidepressant withdrawal; she is also the founder of survivingantidepressants.org. This paper points to how service users have supported each other and helped to taper from antidepressants – especially in the absence of psychiatric help. She writes:

“Framer introduces us to PAWS — Post-Acute Withdrawal Syndrome — which describes the various physical and emotional symptoms that develop as the body readjusts following the adaptations it has had to make while taking the drug. She also touches on ‘neuro-emotions’ — emotions generated by the neurological effects of withdrawal.”

Her work has brought together numerous concerns around antidepressant withdrawal – how to taper, protracted withdrawal, identifying drug reactions, coping methods, etc.

Lewis’ article is another step in making prescribers more aware of the adverse effects of commonly prescribed psychotropics.

 

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Lewis, S. (2021). The four research papers I wish my doctor had read before prescribing an antidepressant. British Journal of Medical Practice. DOI: https://doi.org/10.3399/bjgp21X716321 (Link)

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

5 COMMENTS

  1. As one who had the common symptoms of antidepressant discontinuation syndrome misdiagnosed as “bipolar,” decades ago. I say many, many thanks to all those “service users,” who are actively helping people, and are working to fill this gap in the psychiatric, psychological, and mainstream doctors’ knowledge base. “Service users” who are actively working to properly educate the doctors. Since the psychiatrists and psychologists have been ungodly disrespectfully ignoring, dismissing, and misdiagnosing, their clients real life concerns.

    I will also say that since I’ve had ‘brain zaps’ for almost twenty years now, a common symptom of antidepressant discontinuation syndrome, that the psychiatrists and psychologists seemingly knew nothing about until 2005.

    https://www.cambridge.org/core/journals/psychiatric-bulletin/article/brain-shivers-from-chat-room-to-clinic/642FBBAE131EAB792E474F02A4B2CCC0

    At least some of the antidepressant discontinuation syndrome symptoms, may actually be permanent. And I believe it was Dr. David Healy, who has pointed out that this may also be true of the odd and adverse sexual side effects of the antidepressants.

    So we should be reporting, not just that, “it is not uncommon for the withdrawal effects to last for several weeks or months.” But, instead, that the common adverse effects of the antidepressants, and withdrawal from such, may actually be permanent.

    In my case, I’ve learned to control my “brain zaps,” in my waking hours. And I can actually “brain zap” a headache away in a NY second, which is convenient. But I will say, I do also have those occasional nights when I “brain zap” all night long, which is physically exhausting, so I awake exhausted.

    I’m quite certain that us “experts by experience” should have been listened to, and believed, by the ungodly disrespectful, systemic misdiagnosing, psychologists and psychiatrists, decades ago. And all doctors need to wake up to the reality that big Pharma, and their ‘in the pocket of big Pharma’ psychiatrists, have systemically been deluding way too many with their “invalid” DSM, for decades or longer.

    And I must confess, it makes zero sense to me, why any non-medically trained psychologist or social worker, has the right to “diagnose” anyone with anything, that requires forced treatment with drugs.

  2. This is a very excellent and interesting article, however, the problem also is: that so many of us had not just antidepressants (SSRIS and others) prescribed to them; but also, anti-psychotics (neuroleptics), a benzo or two; Lithium or depakote or some related drug and maybe even a drug like ritalin or adderall. Also, there are many who may have had two or more antidepressants or antipsychotics or the drugs like the “benzos” they claimed were supposed to deal with the side effects. The problem is that so many people must deal with the withdrawal and subsequent adaptation by the brain/body from not just one or two drugs, but a whole poly-pharmacy. Poly-pharmacy is not uncommon with serious diseases that may be life-threatening; but they are tragically popular in the psychiatric community. The sad irony is that the person is usually going through life and its many myriad of changes, then they are slapped with a preliminary, probably false diagnosis to justify the prescribing of at least one or two drugs and then it escalates. It escalates because even with one or two of these drugs, the patient develops “symptoms” and gets sicker and sicker—-all caused by these evil psych drugs, not helped by the evil therapy, the patient must undergo. It is a two thronged evil dagger—psych drugs and therapy—both sadly meant to damage and injure good people; whether these “providers” will admit it or not. Thank you.

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