Researchers Accuse Lancet Article and British Psychiatrists of Minimising Antidepressants’ Withdrawal Effects

In 2019, Dr James Davies (Roehampton University) and I published a review of the research into antidepressant withdrawal effects. We found that more than half (56%) of people experience withdrawal effects and that nearly half of those (46%) describe them as severe.

Our review has been cited over 400 times (Google Scholar Sept 16, 2024), perhaps most importantly in the historic Public Health England (PHE) report, ‘Dependence and Withdrawal Associated with Some Prescribed Medicines‘. Having thoroughly reviewed all the relevant evidence, PHE made a range of recommendations including the unprecedented, but vital, call for dedicated services for people trying to withdraw from antidepressants.

Since then, campaigners have been edging ever nearer to having those PHE recommendations implemented by the National Health Service.

But those efforts took a setback in June, thanks to a seriously flawed review published in the prestigious journal, Lancet Psychiatry, which received major, largely uncritical, attention from the British and international media (eg, the BBC, the Independent, The Guardian, CNN), and which was enthusiastically endorsed by senior British psychiatrists.

The paper, by German researchers Henssler et al., wrongly claimed that withdrawal effects are experienced by only 15% of people who try to come off antidepressants and that only 3% suffer severe symptoms.

Prominent British researchers at University College London, Professor Joanna Moncrieff and Dr Mark Horowitz, immediately publicised some of the paper’s many shortcomings. But mainstream media were busy unquestioningly reporting the Henssler paper, regurgitating its claim that it had showed that our own review had overestimated the incidence and severity of the problem.

For example, The Guardian published a lengthy opinion piece by biological psychiatrist Carmine Pariante (a recipient of drug company funding) under the headline ‘The Myth That Antidepressants Are Addictive Has Been Debunked—They Are a Vital Tool in Psychiatry’ and the byline ‘New research shows that severe withdrawal symptoms are far less common that thought. Depression needs treating.’ Mirroring comments from senior psychiatrists in other media outlets, Pariente wrote:

‘Very rarely, in my clinical practice, patients complain that they cannot stop their medication because of the symptoms when they try. Unpleasant physical or emotional experiences for a few days or a couple of weeks after stopping antidepressants, yes….. But patients who could not stop the antidepressant because of these symptoms? In my 33 years of clinical practice, I can recall them on the fingers of one hand.’

Tragically, this misrepresentation of reality takes us way back to the complaint my colleagues and I lodged with the Royal College of Psychiatrists (RCPsych) in February 2018 when its then-president had written to the Times, similarly claiming “for the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks of stopping treatment.”

I say tragically because the complaint, our review, the PHE Report and much lobbying had eventually persuaded the RCPsych (and our National Institute for Health and Care Excellence [NICE]) to change its position and to update its guidelines to reflect the research evidence. The current President, Dr Lade Smith, reinforced this irresponsible move back to square one when she retweeted Pariante’s misleading article about the deeply flawed Henssler paper, writing ‘This is a MUST read’ and ‘Fear of ADs may interfere with access to effective treatment. (8 June, 2024).

A letter from a British psychiatrist to Dr Smith asking her to retract was unanswered for three months. Eventually, just this week, Dr Smith wrote back to say that her highlighting the research study and Guardian article ‘does not imply a change in position of the College’. We will be watching closely to see whether this means that the RCPsych will not, as feared, be using this sub-standard paper as an excuse to dilute their recently adopted, evidence-based position and guidelines.

Lancet Psychiatry has just published (Sept. 18) two critiques of Henssler’s review.

The first, from five Brazilian researchers led by Dr Luisa Bisol, of the Federal University of Ceara, Fortaleza, identifies five ‘flaws’ in the Henssler paper. The other is by myself and the co-author of the 2019 review Dr James Davies.

We point out, for example, that Henssler et al. ‘base their own estimates primarily on studies averaging 25 weeks duration, with nearly half of their included studies assessing antidepressant use for only up to 12 weeks. The typical antidepressant user, however, takes these drugs for several years.’

We add: ‘The three largest online surveys included in our review document the experiences of hundreds of people who have taken antidepressants for between 1 year and several years (ie, typical antidepressant users).’

Furthermore: ‘Henssler and colleagues report that that only 29% of the studies they included used a structured assessment tool to measure withdrawal. Those that did so found significantly higher incidences of withdrawal symptoms (40% vs 27%).’

Most of the studies in the Henssler review (83%) were drug company funded.

Our letter concludes:

‘Although future research will determine which of the two estimates is more accurate, somewhere between 1.2 million (15%) and 4.7 million (56%) of the 8.5 million people prescribed antidepressants in England alone last year will experience withdrawal effects when they try to reduce or stop taking antidepressants. Public Health England recommends the development of services that help people safely withdraw from psychiatric drugs, but downplaying withdrawal effects can reduce the chances of this happening.’

It is concerning that such a flawed review was published by an esteemed journal like Lancet and even more alarming that senior psychiatrists have endorsed its dangerously misleading claims.

Researchers, clinicians and patients who understand the true extent of this epidemic of people struggling with the withdrawal effects of antidepressants have been working hard to implement PHE’s recommendations for dedicated services and phone lines. Minimising the incidence of withdrawal effects risks undermining those efforts and leaving millions around the world without the help they desperately need.

Comments in our media release accompanying the publication of our letter were as follows:

Dr Joanna Moncrieff, Professor of Psychiatry, UCL:

‘The evidence surveyed in the recent review does not provide a sound basis on which to judge the frequency or severity of antidepressant withdrawal reactions. Most of the studies included in the review were not designed to detect withdrawal, they involved people who had used antidepressants for a few weeks or months only and they were mostly funded by pharmaceutical companies which have little interest in conducting a thorough assessment of withdrawal.

‘Even with these limitations, many of the studies find that withdrawal reactions are common. It is important that debates about the precise incidence of withdrawal do not distract from the need to recognise that withdrawal reactions occur, and to provide support for people who have difficulty coming off antidepressants.’

Dr Mark Horowitz, Clinical Research Fellow in Psychiatry at North East London NHS Foundation Trust and co-author of the recent Maudsley Deprescribing Guidelines:

‘This systematic review minimises the effects of withdrawal by focusing on short-term trials (many less than 12 weeks) that were conducted by drug companies and not designed to look for withdrawal. It is unfortunate that this paper has served to distract from the serious health problems that people experience after coming off long-term antidepressants, with many people now using these drugs for many years.

‘Even if the low-ball estimates of this review are accepted at face value there are still hundreds of thousands of people experiencing severe harm from coming off these medications which the health system is still not adequately addressing.’

Stevie Lewis, one of the many thousands who have had great difficulty withdrawing from antidepressants; Board Member, International Institute for Psychiatric Drug Withdrawal (www.iipdw.org):

‘For those of us who were ignorant of the possibility of antidepressant withdrawal and whose lives were shockingly altered by the severity of it, reading the inevitable academic splitting of hairs of the potential numbers of us is highly frustrating. It is now fully accepted that withdrawal exists, so please may we have appropriate support services put in place to help people who need it.’