In 2023, the BBC released “The Antidepressant Story,” a film that details known, dangerous and sometimes permanent side effects associated with commonly prescribed antidepressants. The documentary features harrowing stories of former patients living with harm from SSRIs, or selective serotonin reuptake inhibitors. They caused persistent sexual dysfunction for a college professor in Iowa who wasn’t warned of its side effects. And they caused dependency in a psychiatric researcher from the UK, who, after ten years of taking it, found himself trapped on the drug after he wanted to stop. While the researcher had just completed his academic training to become a psychiatrist, he received no education at all on the withdrawal issues facing him, as well as more than 1 in 6 patients prescribed antidepressants.
The Antidepressant Story, along with Medicating Normal, Take Your Pills, Anatomy of an Epidemic and Antidepressed are just a few of the growing collective of books and films exposing the overprescribing of psychiatric drugs to Americans, especially veterans. The side effects can be lifelong and sometimes fatal. The US Food and Drug Administration (FDA) does not require warnings for persistent sexual dysfunction, for example, and today the agency is attempting to defend itself from a lawsuit by the consumer advocacy nonprofit Public Citizen, which claims that it failed to respond to a 2018 petition to do so. The authorities that set clinical practice and prescribing guidelines—the Drug Enforcement Agency (DEA), and the Department of Health and Human Services (HHS)—have also not updated their literature to reflect what we have learned about persistent sexual dysfunction or the very common dependency and withdrawal issues associated with some of the most commonly prescribed antidepressants on the market, such as Prozac, Zoloft, Celexa and others. This causes confusion for providers and unnecessary suffering for patients.
I wrote this article because of continued inaction by the FDA, DEA, HHS and the Department of Veterans Affairs (VA) to inform veterans, their families—and all Americans—of the dangerous risk profiles of the drugs they’re prescribed. To those who feel they are benefiting from these medications, I’m thankful you found a treatment to help you navigate the throes of depression, the crushing weight of anxiety, painful post-traumatic stress, or other challenging struggles. Still, you and your family should be aware of the possibility of side effects in the future and being made aware does not mean the doctor softly saying “Well, there are some known side effects, but how about we try this?”
SSRI antidepressants and other blockbuster psychiatric drugs were released in the late 1980s and early 1990s. It seemed then that pharmaceutical companies had discovered scientific, targeted treatments for depression, free of side effects. But as the opioid epidemic taught us, silver bullet solutions are not simple or silver; they may come with great risks.
As The New York Times reported in 2018, patients who “try to stop taking the drugs often say they cannot.” It cited a survey of 250 long-term use of psychiatric drugs, mostly antidepressants, where “about half who wound down their prescriptions rated the withdrawal as severe. Nearly half who tried to quit could not do so because of these symptoms.” And a study of 180 longtime antidepressant users found that more than 130 reported withdrawal symptoms, “with some of those effects being severe and long lasting.” Nearly half said they believed they were trapped on the antidepressant drugs they were prescribed. Many were not aware of these risks prior to starting them.
The most severe side effect extends to suicidality and thoughts of self-harm. In 2004, in response to Kim Witczak and other surviving families, the FDA began requiring SSRI drugmakers to add a Box Warning on the packaging of all SSRI antidepressants related to suicide risk. A Box Warning, according to an article in the AMA Journal of Ethics, is “the most severe warning the FDA can place on a drug short of an outright ban.” Sadly, this class of drugs had been on the market for more than fifteen years before this warning was added. Through that lens, we should not be surprised to continue finding severe side effects with this class of medications.
I understand these concerns all too well. In 2019, I published my story of withdrawal from an SSRI antidepressant known commercially as Zoloft. I shared my surprise and alarm when I tried to stop taking Zoloft after being prescribed the drug for a year and titrating down in dosage for two weeks. I experienced panic attacks, “brain zaps,” paranoia, thoughts of self-harm, physical pain—it was an excruciating year-long withdrawal.
Millions of others share this experience. For veterans, it’s especially challenging: 28% of all veterans treated at the VA are prescribed antidepressants and 68% are prescribed psychiatric drugs. About 70-80% of veterans treated at the VA for depression or post-traumatic stress are prescribed antidepressant medications. The Government Accountability Office has shown that 94% of veterans treated at the VA for depression are prescribed antidepressant medications.
The VA itself says that veterans between the ages of 18 and 34 are at the greatest risk of suicide. This group is also prescribed antidepressants at the highest rate, and this group, according to the FDA’s Box Warning, that’s at greatest risk of adverse events.
I share this with you and ask you to share it with others. Based on current prescription rates, you or someone close to you is likely taking an SSRI. Talk about potential side effects with your loved ones, friends, and family members. And to those now taking SSRIs—or any type of psychiatric medication—DO NOT ABRUPTLY STOP TAKING YOUR MEDICATIONS. If you have concerns or want to consider discontinuing your medications, only do so after consulting your prescriber.
If you would like to learn more, please join us in Eaton Rapids, Michigan, on 15 October, 2024, for the “Michigan Veterans Harm Reduction Summit: Exploring the Relationship Between Medication & Veteran Suicide.” This summit is hosted by the Grunt Style Foundation, in partnership with the Michigan Veterans Affairs Agency, the Michigan Commander’s Group, the American Legion Department of Michigan and the VFW National Home. We will learn from some of the world’s leading experts and clinicians on this issue, along with those who have lived these experiences themselves. We would be honored to have you join us as we learn about ways of reducing harm and increasing the quality of care within the veterans and military community!
Derek, I appauld your efforts and would like to also mention the historical aspects of veteran treatment.
WWI especially in England and to the elite brought various non medical supports. This has been and off and on again issue that has never fully been explored. Many allied health professions done forgotten like the dance therapy developed by Trudy Schoop were and could be made available.
Please look or have someone investigate old forgotten supports and new creative ones. Your service should be if nothing else honored by excellent care.
My father was in the front lines ahead if the MASH units in the Korean War. I can now look back and think oh this was a flashback but he is gone and did not tell much of his story a sentence here a word or two there. Everyone involved in service should have support for processing all the memories of before, during, and after service. Thank you for your efforts.
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Derek,
I met a lady whose Veteran husband set the house on fire with him in it. She had reports from the coroner saying he died of smoke inhalation, the police report and witnesses that saw him pouring the gasoline. The toxicology report showed levels of psych drugs 10 times the recommended, and the VA denied it was a suicide because he didn’t leave a SUICIDE NOTE.
So their way of cutting down numbers may not be the same as yours. Remember that.
Since I’m a volunteer educator for a Veteran’s group and lost my son to suicide I’ll be happy to tell you what I know about SSRI’s and suicide. Will email you
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Don’t give psychological medicines to veterans because they might get dead.
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Though we don’t know via adequate scientific trial, if psychedelics are disease altering agents or whether they work like a superprozac , meaning dump a bolus of chemical like serotonin, into the neural cleft, perhaps struggling veteran would be willing to risk an emergency room visit in order to give it a shot. They may just work symptomatically via the same old mechanisms as do conventional antidepressants; we shouldn’t delude ourselves that these agents have truly novel mechanisms. We should go into this brave new world with eyes open
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Dear MD,
Do you realize that many people with psych conditions (up to 50% in some studies) have MTHFR mutations that cause low Folic Acid, Vit B12 and Vit D and antidepressants and antipsychotics lower the same three things?
You need Folic Acid and Vit B12 to be able to recycle homocysteine and make SAMe, which you need to make neurotransmitters. So if psychedelics work as a superprozac, then we can expect many will be hurt.
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How about making the connection between Veteran suicide and the Gov’t shrinks labeling combat Vets with “Personality Disorders”… then the military kicked them out of the service with “Bad Conduct” discharges.
THOUSANDS of Vets who started showing signs of combat stress were quickly diagnosed with “Personality Disorders”, ergo, immediate Other Than Honorable Discharges. That shame alone would make many want to kill themselves.
Don’t believe me, see the YouTube video I posted 2 years ago… https://www.youtube.com/watch?v=owD9GcC1pXU
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They did it to many Vietnam Veterans. They used a history of any type of childhood adversity as an excuse to diagnose with Borderline personality. But they have failed to consider that some of the recruits were only 17 and the military provided multiple stressors, including giving them hepatitis C with the instrument used to immunize them (info on jet gun transmission can be found at HCVets.com).
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Here’s a document saying the military “has a systemic personality disorder discharge problem” and showing it discharged thousands illegally.
https://law.yale.edu/sites/default/files/documents/pdf/Clinics/VLSC_CastingTroopsAside.pdf
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It’s almost as if our foreign enemies have been hired within the military and VA, and are actively trying to destroy our warfighters within the labyrinth of bureaucracy.
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