Antidepresan: Salgın Antidepresan Zararı ve Bağımlılığının Çığır Açan İncelemesi - İngizlice kopya
Table
of Contents
Table of Contents......................................................................................... 2
HOW OUR MENTAL HEALTH BECAME MEDICAL.......................................... 18
THE MYTH OF THE CHEMICAL IMBALANCE................................................. 21
THE UNRECOGNIZED POWER OF THE PILL................................................. 23
MENTAL HEALTH: THE BUSINESS............................................................... 26
ALTERNATIVES WORTH CONSIDERING....................................................... 30
BEING INFORMED ABOUT OUR TREATMENT OPTIONS............................... 32
THE IMPORTANCE OF INFORMED CONSENT............................................... 34
KNOWING ANTIDEPRESSANT BENEFITS AND RISKS.................................... 38
THE MANY ADVERSE EFFECTS INCLUDING AKATHISIA................................. 44
Anosognosia or Medication
Spellbinding........................................... 57
ANTIDEPRESSANT-INDUCED SUICIDE......................................................... 63
ANTIDEPRESSANTS AND OUR “MEDICALLY UNEXPLAINED SYMPTOMS”..... 69
BECOMING OUR OWN ANTIDEPRESSANT EXPERT...................................... 75
ANTIDEPRESSANT LONG-TERM EFFECTS.................................................... 76
Possible Long-Term Effects............................................................... 78
Chronic Brain Impairment (CBI)............................................................ 78
Dementia............................................................................................. 78
Diabetes............................................................................................... 79
Tardive Dysphoria................................................................................ 79
Treatment Resistant Depression........................................................... 80
Tolerance............................................................................................. 80
DEPENDENCE AND OUR NEW BALANCED STATE........................................ 82
Dependence on antidepressants can
make us vulnerable................. 83
WITHDRAWAL: THE RELAPSE TRAP AND RESEARCH................................... 86
ADOPTING A HARM REDUCTION APPROACH.............................................. 96
LEARNING ABOUT OUR ANTIDEPRESSANTS AND LISTENING TO OUR BODY 99
Counselling and Talk Therapy............................................................. 102
WITHDRAWAL AND THE EXISTING
PROFESSIONAL ADVICE........................ 104
SAME BUT NOT THE SAME: UNDERSTANDING GENERICS......................... 109
PRESCRIBING ANTIDEPRESSANTS TO CHILDREN AND YOUNG PEOPLE.... 112
THE ELDERLY, VULNERABILITY AND ANTIDEPRESSANTS........................... 117
ANTIDEPRESSANTS, THE ARMED FORCES, PTSD AND SUICIDE.................. 120
Description.................................................................................. 120
Scale............................................................................................ 121
THE RESOURCE GUIDE GENERAL DRUG INFORMATION......................... 186
Inner Compass Initiative/The
Withdrawal Project/Connect.............. 189
ICI Connect...................................................................................... 189
Surviving Antidepressants............................................................... 190
Harm Reduction Guide to Coming Off
Psychiatric Drugs/Will Hall.... 190
RxISK............................................................................................... 190
Psychiatric Drug Facts with Dr.
Peter Breggin MD............................ 190
Mad in America............................................................................... 190
Mad in the UK................................................................................. 191
The Council for Evidence-based
Psychiatry...................................... 191
Let’s Talk Withdrawal....................................................................... 191
Medicating Normal.......................................................................... 191
MIND.............................................................................................. 192
Robert Whitaker Books................................................................... 192
Fiddaman Blog................................................................................ 192
Akathisia Alliance for Education and
Research................................. 192
MISSD............................................................................................. 193
Bloom in Wellness........................................................................... 193
The International Antidepressant
Withdrawal Project...................... 193
International Coalition for Drug
Awareness..................................... 193
The International Society for
Ethical Psychology and Psychiatry, Inc. (ISEPP) 194
The International Institute for
Psychiatric Drug Withdrawal............. 194
AntiDepAware................................................................................. 194
SSRI Stories: Antidepressant
Nightmares......................................... 195
Institute for Safe Medication
Practices............................................. 195
TaperMD......................................................................................... 195
Open Dialogue................................................................................ 195
Everything Matters—Beyond Meds................................................. 196
Warfighter Advance......................................................................... 196
A Disorder For Everyone.................................................................. 196
Chaya Grossberg............................................................................. 196
Emotional CPR................................................................................ 197
Integrative Mental Health for You.................................................... 197
The OLLIE Foundation..................................................................... 197
Human Givens................................................................................ 198
Compassionate Mental Health........................................................ 198
The Icarus Project............................................................................ 198
Epidemic Answers........................................................................... 199
UK Post SSRI Sexual Dysfunction
Organization................................ 199
Antidepressant Risks: Helping People
Understand the Risks of Taking Antidepressants................................................................................... 199
Canada Post SSRI Sexual Dysfunction
Organization......................... 200
Critical Psychiatry Network.............................................................. 200
Informed Consent and Prescribing.................................................. 206
Withdrawal/Tapering....................................................................... 206
Patient Experiences......................................................................... 209
Report Your Withdrawal Experience................................................ 209
Canada........................................................................................... 209
Guidelines for Switching From One
Antidepressant to Another....... 210
Tapering Strips................................................................................ 210
Adverse Effects................................................................................ 210
Akathisia......................................................................................... 212
Dependence.................................................................................... 212
Drug Interactions............................................................................ 212
Antidepressants and Suicide........................................................... 213
Overprescribing.............................................................................. 213
Medically Unexplained Symptoms................................................... 214
Generics.......................................................................................... 214
The Role of Relatives and Friends in
Antidepressant Treatment....... 214
Drug Interactions............................................................................ 215
Antidepressants and Young People................................................. 215
Antidepressants and the Elderly...................................................... 216
Antidepressants and Veterans......................................................... 216
Social Media Support Groups.......................................................... 217
Counseling/Psychotherapy.............................................................. 217
INTRODUCTION.............................................................................. 219
PART 1............................................................................................ 220
PART 2............................................................................................ 221
PART 3............................................................................................ 229
PART 4............................................................................................ 230
PART 5............................................................................................ 232
PRAISE
FOR ANTIDEPRESSED
“...a
valuable input to the process of change in global mental health and an
essential book for both users and providers of mental health services.”
—Dainius Pūras, MD,
Professor of Child and Adolescent Psychiatry
and former UN Special Rapporteur on the Right to Health
“...vital
to understanding SSRIs and other antidepressants.”
—Will Hall, MA,
author of The Harm
Reduction Guide to Coming Off Psychiatric Drugs
“...essential
reading for anyone prescribing or taking antidepressants.”
—Marion
Brown, BSc, MBA, HG.Dip.P
“...a
book every medical professional should read.”
—Jill Nickens,
founder
of Akathisia Alliance
“...provides
a summary of what you need to know which has been difficult to access before
now.”
—Dr.
Sian F. Gordon, MBChB, MRCGP
“...a
powerful examination of the potential consequences of an overtly medical
response to emotional distress.”
—James Moore,
host of the Let’s Talk Withdrawal and Mad in America podcasts
A BREAKTHROUGH EXAMINATION
OF EPIDEMIC ANTIDEPRESSANT
HARM AND DEPENDENCE
BEVERLEY
THOMSON
Visit us at www.hatherleighpress.com
and register online for free offers, discounts, special events, and more.
ANTIDEPRESSED
Text Copyright © 2021 Beverley Thomson
The Medicalization
of Our Mental Health and Antidepressant Prescribing
1: How Our Mental
Health Became Medical
2: The Myth of the
Chemical Imbalance
3: The Unrecognized
Power of the Pill
4: Mental
Health:The Business
PART 2
The Power of the
Informed Patient
5: Alternatives
Worth Considering
6: Being Informed
About Our Treatment Options
7: The Importance
of Informed Consent
8: Knowing
Antidepressant Benefits and Risks
9: The Many Adverse
Effects Including Akathisia
10:
Antidepressant-Induced Suicide
11: Antidepressants
and Our “Medically Unexplained Symptoms”
12: Becoming Our
Own Antidepressant Expert
13: Antidepressant
Long-Term Effects
14: Dependence and
Our New Balanced State
15: Withdrawal: The
Relapse Trap and Research
PART 3
Safe Antidepressant
Management and Withdrawal
16: Adopting a Harm
Reduction Approach
17: Learning About
Our Antidepressants and Listening to Our Body
18: Withdrawal and
the Existing Professional Advice
PART 4
Special Concerns
19: Same But Not
The Same: Understanding Generics
20: Prescribing
Antidepressants to Children and Young People
21: The Elderly,
Vulnerability and Antidepressants
22:
Antidepressants, the Armed Forces, PTSD and Suicide
PART 5
Patient Experiences
CONCLUSION
THE RESOURCE GUIDE
Useful Resources
Additional Reading
Key Articles,
Information and Research
Acknowledgments
References
….
For my son Cameron
and my husband David
PREFACE
Dear Dr.
Gordon,
I have been suffering from extremely severe
withdrawal symptoms from the antidepressant drug paroxetine for over six months
now. These symptoms include but are not limited to: body and head jerking,
severe agitation, hyperventilation to the point of passing out, and waves of
“toxic depression”.
I admitted myself to hospital after a
failed attempt to take my own life. They discharged me after 10 days as there
was nothing they could do for/with me and I was becoming a burden on the nurses
and the other patients.
Every second of my waking existence is
horrific. I have repeatedly expressed my wish to die with dignity as I am now
unable to maintain even the most basic standards of personal hygiene. I have
socially isolated to the extreme as my condition makes associating with people
impossible.
In my desperate state I have contacted the
group “My Death My Decision” as well as the group “Exit international” so they
will have a record of my experience even though there is nothing they can do to
help me.
You have my permission to share my
correspondence with anyone you deem to be appropriate.
Yours sincerely,
Antony Schofield
|
THIS BOOK COMES too late
for Antony Schofield. He ended his life aged 52. Being prescribed
antidepressants was the start of a ruined and wasted life. I talk with his
mother often; at 81, she was left with only memories of a wonderful,
intelligent and adventurous son. Antony’s mum is now aware of and understands
the effects these drugs, taken as prescribed, had on her son’s life. It was
Antony’s wish, and is now his mother’s, that people should learn about the harm
these medications have the potential to cause. Towards the end of his
suffering, he asked his mother to “tell the world” about antidepressants. This
book is the voice of Antony and his mum Bridget.
INTRODUCTION
Our
“Wicked” Problem with Antidepressants
“Wicked’” refers to a problem that cannot
be fixed, where there is no single solution to the problem. “Wicked” denotes
resistance to resolution, rather than evil. Another definition is “a problem
whose social complexity means that it has no determinable stopping point and
because of complex interdependencies, the effort to solve one aspect of a
“wicked” problem may reveal or create other problems.”1
|
NOWADAYS, WE TALK about the
urgent need for a paradigm shift in how we think about mental health and for
“transformation in the way we collectively understand and intervene on mental
health issues.”2 The reality is we need a
revolution. In 2020, the United Nations published a report3 by Special Rapporteur Dainius
Pūras calling for “little short of a revolution in mental health care.”4
It is important to remember,
whatever we need to do to make change and however loud we shout about emerging
new ways of thinking, antidepressant prescribing is continuing to soar around
the world. The medicalized way we look at mental health has become a dominant
and powerful one and millions of us have chosen to take antidepressants knowing
very little about them. Whilst the medical profession has a responsibility to
“first do no harm,” we, as patients also have a responsibility to learn about
this medication we take, often with very little thought. It is hoped that this
book will enable us to become savvy about antidepressants, make informed
choices and contribute to changing how we think about, talk about, and cope
with life’s up and downs.
Mental “illnesses” are amongst the most
common health conditions in the United States.
·
More than 50% will be diagnosed with a
mental illness or disorder at some point in their lifetime.
·
1 in 5 Americans will experience a mental
illness in a given year.
·
1 in 5 children, either currently or at
some point during their life, have had a seriously debilitating mental illness.
·
1 in 25 Americans lives with a serious
mental illness, such as schizophrenia, bipolar disorder, or major depression.5
The US has declared itself to be in the
grips of a mental health epidemic. According to Centers for Disease Control and
Prevention (CDC) data, one in seven—or 13.2 percent—of adults aged 18 and over
took antidepressants between 2015 and 2018; more than 43 million adults. Use
was higher amongst women, 17.7 percent, than men, 8.4 percent. This increased
with age, rising to 24.3 percent of all women aged 60 and above. Teenagers,
aged 13-19, experienced the greatest increase in antidepressant use from 2015
to 2019, up a significant 38.3 percent, from 5.7 percent to 7.9 percent.6,7 This significant rise in use
amongst young people is alarming. One study reports the number of young people
with major depression jumped 52 percent between 2005 and 2017. In addition, 1
in 8 young Americans now suffers from anxiety.8
This is written at the time of
COVID-19 and already in the US there have been significant increases in the
prescribing of drugs used to treat mental health conditions. Statistics for
2020 show 45 million Americans were taking antidepressants and this included
2.1 million young people aged 0-17. By March 2020, it was reported
prescriptions for antidepressants had risen by 19%, anti-anxiety medication by
34 percent and anti-insomnia drugs by 15 percent. Reports tell of 40 million
Americans suffering from anxiety and over 17 million being diagnosed with Major
Depressive Disorder.9
The American Psychiatric Association
(APA) Practice Guideline for the Treatment of Patients with Major Depressive
Disorder recommends antidepressants or psychotherapy as the initial treatment
for patients with mild-to-moderate depression.10 Yet financial costs prevent
many Americans accessing medication or therapy. It is also reported there is a
severe lack of mental health professionals available with a shortage of
counsellors, social workers, psychiatrists and psychologists. Only one-third of
those diagnosed receive treatment because of the cost of care, according to the
Anxiety and Depression Association of America.11 The U.S. Department of Health
and Human Services says approximately 111 million Americans live in areas with
a shortage of mental health professionals.12
Despite prescription statistics,
there has never been any sound evidence for the epidemic of depression talked
about. We do, however, have a mental health pseudo epidemic in the western
world and the case of an epidemic of antidepressant prescribing is a reality.
The surge in antidepressant prescribing has always been a growing cultural trend
as well as a medical one. It reflects the rise of the “medicalization” of
everyday life and is one which comes at a cost to individuals and society.
Unfortunately, the promotion of “mental health” as medical conditions has led,
primarily, to the increase in the prescribing of antidepressants and it is now
becoming widely recognized that antidepressants can put us at risk of dangerous
adverse effects; most notably they can cause dependence and raise the risk of
suicide. It is also ironic that as antidepressant prescribing continues to
soar, so does mental health disability.13
Dependence on antidepressants is an
issue lacking much needed recognition; a worldwide “elephant in the room,” and
for many it can be personally, socially, or politically uncomfortable to deal
with. It can be embarrassing, controversial, inflammatory, and downright
dangerous. The pharmaceutical industry, psychiatry and doctors are supported by
governments and mental health organizations and charities in propagating the
unsubstantiated basis on which mental health has grown to be a huge industry.
They have made antidepressants the medication so many of us have come to depend
on. Many of us claim antidepressants have saved our lives, but many are unaware
of the harm antidepressants have caused or of our dependence on the medication
we take as prescribed.
Just as happened with the campaigns in the
1990s, the drug companies will no doubt seize the potential COVID-19 presents
as an opportunity to capture new customers, expand existing mental health
markets, and introduce their medical model of treatment to new ones. In the
1990s, Eli Lilly and the field of psychiatry created an incredibly successful
epidemic of pseudo-depression. By 2000, Prozac had 40 million users and
accounted for a quarter of Eli Lilly’s $10.8 billion sales and more than a
third of its $3 billion profit. Before Prozac arrived, the general public were
against antidepressants and believed them addictive.
Media language during COVID-19 is
serving to assist the pharmaceutical industry to further boost its profits
during and in the aftermath of the crisis. This is a time when language matters
and we must be aware of similar campaigns to “Defeat Depression” and
“Depression Hurts;” crusades which in the 1990s led to the unsubstantiated
medicating of our mental health and to millions today being dependent on and
harmed by antidepressants.14
It is important we are not duped into falling for a well-orchestrated “Defeat
COVID-19 Mental Illness Campaign” or “COVID-19 PTSD Campaign,” which are
probably already in the planning stage. The future mental health of a
generation now depends on the powerful language used to help us cope with our
lives during this time.
Overtreatment with antidepressants
and underestimation of risks have left millions around the world with problems
to which there are no obvious solutions. Current levels of antidepressant
prescribing are unsustainable for many reasons. It is a human time-bomb,
sometimes fueled by the willful blindness of both patients and medical
professionals. Failure to acknowledge the issues is leading to harm and death
and when the issue of dependence is raised, other problems present themselves
due to the lack of research, knowledge, and existing support for those who
choose to withdraw from antidepressants.
Vulnerability is hardly ever spoken
about in relation to antidepressants and yet, it is the one adverse effect we
will most probably be prescribed with our medication. We can be vulnerable to
physical and psychological adverse effects and vulnerable when dependence
causes changes to our health, sometimes leading to many aspects of our life
spiraling out of control.
This book acknowledges a problem too
complex to solve but offers an opportunity to learn, open minds and explore
options to avoid and reduce harm and dependence. People, right now, need help
and there is little available. In an ideal world we talk about “withdrawal”
from antidepressants but for many, managing their antidepressants has become a
process of damage limitation. Mental illness is not a disease but is described
as an epidemic and unless we challenge the current mental health
narrative—unless we educate ourselves and learn about the powerful drugs we
take, we will see more suffering, illness and death.15
Taking an antidepressant is an
individual’s choice. I hope this book is one people will refer to when making
the choice to start taking antidepressants and whilst taking them or
considering reducing or managing their medication. It is honest and straight
forward about the realities of the effects of Selective Serotonin Reuptake
Inhibitors (SSRIs) and Serotonin Norepinephrine Reuptake Inhibitors (SNRIs).
Taking an antidepressant should be
our informed choice based on the benefits and risks. There are things it is
important we know about SSRI/SNRI antidepressants and things we need to look at
differently. The reality is there are many things we still don’t know about
these drugs. What we are told about an antidepressant will initially depend on
our prescriber, but only some will be knowledgeable and honest; that it seems
impossible to predict how our mind and body will react to the medication.
There is now so much information
available in books and online resources about the benefits and adverse effects
of antidepressants. Some information is reliable and easily accessible but for
many it can appear complex and daunting. I explain the realities of the
“wicked” issue of antidepressants by presenting evidence-based facts and
real-life experiences. I have known too many people who wish they had been
fully aware, before they swallowed their first pill, of the realities of a life
“Antidepressed”.
This book does not
contain medical advice! It encourages and helps us learn about
SSRI/SNRI antidepressants and guides us to appropriate resources enabling us to
make more informed choices. The resource section of this book includes valuable
sources of information including websites, books, articles, and research.
WARNING: There are
many reasons why it is important that we never stop taking or start withdrawing
antidepressants or any psychotropic medication without the support of a
knowledgeable medical professional or support service. Antidepressant treatment
should be supported by frequent reviews. We need to be aware, from the very
first pill we take, of any physical or psychological changes we experience and
report them immediately to our prescriber. Evidence suggests the risk of
suicide, self-harm or other severe adverse events is significantly higher when
commencing, stopping or changing doses or switching drugs including generics.
This book includes petition extracts
from people around the world. The petition called for the Scottish Parliament
to urge the Scottish Government to take action to appropriately recognise and
effectively support individuals affected and harmed by prescribed drug
dependence and withdrawal.1
In this
book, “antidepressants” refers to SSRI/SNRI antidepressants unless otherwise
stated.
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) |
|
GENERICS |
BRAND NAMES* |
Citalopram |
Celexa, Cipramil |
Escitalopram |
Cipralex, Lexapro |
Fluoxetine |
Prozac, Sarafem |
Fluvoxamine |
Luvox, Faverin |
Paroxetine |
Paxil, Seroxat |
Sertraline |
Zoloft, Lustral |
SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs) |
|
GENERICS |
BRAND NAMES* |
Desvenlafaxine |
Pristiq |
Duloxetine |
Cymbalta |
Levomilnacipran |
Fetzima |
Milnacipran |
Ixel, Savella |
Venlafaxine |
Effexor |
Sertraline |
Zoloft, Lustral |
*These drugs have many different brand names throughout
the world. Medications might be available in tablet, capsule, or liquid form. |
PART 1
The Medicalization of
Our Mental Health and
Antidepressant Prescribing
1
HOW OUR MENTAL
HEALTH
BECAME MEDICAL
Why do so many of us believe we might be
“mentally ill” and need medication? Why have we been made to believe “mental
health” is a medical issue?
We are told our mental health deserves
parity with our physical health. Campaigns by often self-serving organizations
have encouraged the developed world to see mental health as being part of our
medical system. Reality is, physical health treatment is targeted at the
biological cause of an illness, but mental health treatment should be primarily
about helping us cope with the many personal and societal factors negatively
affecting our ability to cope with our lives. Nowadays, however, it seems to
suit both doctors and patients to readily accept medication as the answer
rather than address the issues causing our stress, anxiety or sadness.
Something is probably wrong,
difficult, uncomfortable, or downright hard in our life but millions of us are
not actually “mentally ill”. Psychiatry and the pharmaceutical industry have
created a system of mental health to attempt to reflect diagnostic models used
in other areas of medicine. This is to justify psychiatry’s status as a medical
profession and the prescribing of antidepressants and other psychiatric
medications.
Most of us have never heard of the
Diagnostic and Statistical Manual of Mental Disorders or the “DSM” as it is
known. The 5th edition of this manual, (DSM-5), was published in 2013 following
work groups creating hundreds of papers and articles to provide the world with
a summary of the state of the supposed “science” relating to “psychiatric
diagnoses”. This current edition of psychiatry’s bible lists over 300 disorders
or illnesses for which we are likely to be prescribed antidepressants or other
psychotropic medication. It is perhaps the most powerful and influential book
we have probably never heard of.16,17,18
Using this manual as their
justification, our doctors are taught to categorize our emotional feelings and
subjectively and often inaccurately diagnose us as suffering from disorders and
conditions. These are not biological diseases and there are no proven biological
causes, but it has led to a cultural perception that depression, grief,
sadness, anxiety and other normal human feelings and behaviors should be
classified as mental illness. Psychiatry’s classifications have become part of
our culture and encouraged us to accept our suffering and inability to cope as
mental health issues needing medical treatment .
The DSM categories are labels and
patients are matched to them using the opinion of the doctor listening to the
patient’s own feelings about themselves when asked certain questions. This is
not a scientific process and has many flaws; are we always being honest with
the doctor and is the doctor always asking the right questions and listening
correctly? Do we feel exactly the same from one day to the next? Are there
reasons we think a diagnosis will make life easier? A doctor’s often
subconscious reference to conditions created for this “guidebook” is for many
of us the start of our feelings and emotions being defined as mental illness,
antidepressants or other drugs being prescribed, and the real-life issues we
need to address being ignored.
Without us even recognizing it,
psychiatry’s DSM has become a dominant part of how we deal with everyday life.
Whether we have heard of the DSM of not, its conditions have become part of our
everyday language. A doctor will probably not even refer to it, but we have
allowed it to mislabel normal emotions and feelings and encourage both
overdiagnosis and inappropriate use of medication. There now seems to be a pill
for every emotional situation we might find ourselves in and a label for every
inconvenient or uncomfortable feeling. The covert DSM has been cleverly and
unceremoniously drilled into our psyche and until very recently we have
generally accepted it without question.
Ultimately, unless we are informed
and question their opinion, whether or not we end up on medication is often
decided by little more than a doctor’s subjective diagnosis. Many of us who
could quickly improve with time, the support of friends and family or therapy,
might not be given the right sort of help we need. A doctor’s appointment is
often the start of a lifelong journey as a psychiatric patient resulting in a
stigmatizing lifelong condition and dependence on psychiatric medication.
Is there any wonder we have come to believe
“a pill” can make life easier? Why do so many of us turn to antidepressants to
help us cope with life’s difficulties?
Prozac (and the language that came with it)
changed everything.
“Defeat Depression” and “Depression
Hurts” campaigns became some of the most influential and successful marketing
campaigns of our era. We suddenly had mental health and mental illness and the
simple solution was to be found in a psychotropic drug branded “Prozac”.27
Prozac, the first SSRI
antidepressant was introduced in 1988. Eli Lilly marketed it as “happiness in a
blister pack”. Prozac, generic/medical name fluoxetine, was quickly given to
Interbrand, the world’s leading branding company and it was given its identity.
Over the following years, national campaigns informed doctors and the public of
the dangers of depression.28
Prozac was pushed as a wonder drug,
entirely safe, an easy answer to “the blues”. It fixed our faulty brains. On
launch day patients were already asking for it by name. And with powerful
marketing we were brainwashed into believing depression was a biological
disease, chemical imbalances needed balancing and everything could easily be
cured by a drug. A new kind of depressed patient was “created” and they had
mild depression needing medical treatment. They were the ordinary people with
ordinary life struggles and were sold the idea that a drug could make their
life better.
Campaigns assessed public attitudes
towards depression to discover which of them “needed” to be changed. Eli Lilly
then began changing the public’s opinion about antidepressants. Conclusions
were made “Doctors have an important role in educating the public about
depression and the rationale for antidepressant treatment.” In 1997, Eli Lilly
ran a new marketing campaign for Prozac with direct-to-consumer advertising.
Advertisements appeared in over 20 general-interest magazines and targeted both
adults who suffered from depression and their family and friends. Their target
market was the new, first-time depressed patient and their messages were
“Depression Hurts” and “Prozac can Help”.
Initially, The American Medical
Association (AMA) were not overly enthusiastic about Eli Lilly’s strategy, “Of
course, doctors can—and should—say no to anyone who doesn’t need a particular
medication. But let’s not fool ourselves: If doctors are under pressure from
their patients to prescribe a particular medication, they must become strong
gatekeepers to prevent misuse.”29
At this time there was no internet and we relied on doctors and the
pharmaceutical company’s Patient Information Leaflet for information and
advice. There were no social media groups for support if we needed it. We
became guinea pigs in the new medicalized way of dealing with life. It was
nothing short of the start of a worldwide unauthorized human experiment which
continues today, unabated.
In the TIME Magazine 2003 article
“If everyone was on Prozac... ”, Dr. Sanjay Gupta asked, “[T]hat raises an
intriguing question about the future of mood-altering pharmaceuticals: If
Prozac can make you feel better even if you are not depressed, why shouldn’t we
all be taking it? Is that the direction we’re going, as the drugs become more
socially acceptable and heavily marketed? (More than 11 million Americans
already take some form of antidepressant.) It’s a question that arises only
because SSRIs are relatively mild and subtle medications. There are plenty of
drugs that can make you feel better, at least temporarily—alcohol and heroin
come immediately to mind—but they tend to be addictive or toxic or both. Prozac
is neither.”30
We now know antidepressants can be
highly toxic and probably cause dependence for the majority of those who take
them. The pharmaceutical industry and psychiatry are supported by governments,
the medical profession, the media and mental health organizations and charities
to continue to promote the unsubstantiated basis on which mental health has
grown to be a huge industry and these drugs are “sold” to us. The clever
marketing of Prozac assisted the birth of the “medical model” of mental health
and we adopted it, until recently, without question.
2
THE MYTH OF THE
CHEMICAL IMBALANCE
We are told it’s our “chemical imbalance”,
but where’s the proof? Why don’t we have tests or scans to confirm this
imbalance?
There are no biological tests such as blood
tests or brain scans which can be used to provide independent objective data to
support our mental health diagnosis. We have all probably heard of and believed
in the “chemical imbalance” theory or that we might have “it” because we are
predisposed genetically; “my mother suffered from it” or “it runs in the
family”.
Despite everything we might have
been told about chemical imbalances, there are no known biological causes for
any of the psychiatric and mental health disorders or illnesses apart from
dementia and some rare chromosomal disorders.31 We are being medically treated
for conditions which are most probably not biological.
By means of the carefully scripted
pharmaceutical marketing campaigns of the 1990s and pushed by psychiatry, our
doctors quickly learned to attribute mental illness to faulty brain
biochemistry, defects of dopamine, or a shortage of serotonin. They bought into
it, we bought into it and most of us still believe it now. For over 30 years we
have all been conditioned to believe what is now starting to be regarded as
very questionable science. Research has mostly shown evidence that the brain,
which has around 100 billion neurons and is one of the most complex objects in
the universe is in fact an elusive target for drugs. It is just way too
complicated for it to be as simple as we are led to believe.
From an early age we are taught
“doctor knows best”. Most of us trust, without question, that our doctors
adhere to their principle of “first do no harm”. We have accepted without
question their story that our brain chemistry is at fault and these false
perceptions of how our brains work have made it easy for us to accept that we
might be mentally ill, and antidepressants are the answer. The fact is there
are no associations with any biological pathology in relation to the majority
of psychiatric diagnoses. Conditions which have become part of our everyday
language such as bipolar disorder, depressive disorders, anxiety disorders,
personality disorders, obsessive compulsive disorders or post-traumatic stress
disorders have no associations with any biological pathology.
There is an absence of scientific
evidence to support the supposed “chemical imbalance” theory and many eminent
professionals are now openly questioning the validity of the theory. It is now
being described as last-century thinking, misleading and unscientific
“biobabble”.
Although scientists have been
testing the chemical imbalance theory’s validity for over forty years and despite
thousands of studies, there is still not one piece of direct evidence proving
the theory correct. The chemical imbalance theory, in relation to any mental
health disorder is unsubstantiated.
This chemical imbalance story,
countlessly repeated on antidepressant commercials and by psychiatrists from
prestigious institutions, has been so effective that it comes as a surprise to
many Americans—including Alix Spiegel—to discover that the psychiatric
establishment now claims that it has always known that this theory was not true
or “urban legend,” the term used by Ronald Pies, Editor-in-Chief Emeritus of
the Psychiatric Times. Pies stated in 2011, “In truth, the ‘chemical imbalance’
notion was always a kind of urban legend—never a theory seriously propounded by
well-informed psychiatrists.”
Truly well-informed psychiatrists
have long known that research showed that low serotonin (or other
neurotransmitter) levels were not the cause of depression. The 1998 American
Medical Association Essential Guide to Depression stated: “The link between low
levels of serotonin and depressive illness is unclear, as some depressed people
have too much serotonin. But the vast majority of Americans—who didn’t read
this textbook—never heard this.”32
The American Psychiatric Association
website gives the following information regarding the association between
depression and brain chemistry which they say “may” exist; “Medication: Brain
chemistry may contribute to an individual’s depression and may factor into
their treatment. For this reason, antidepressants might be prescribed to help
modify one’s brain chemistry.”33
So why do we still buy into mental
health being a medical issue? For many of us a doctor’s or psychiatrist’s
diagnosis validates the way we both feel and act. It can be easier to blame our
faulty brain chemistry rather than dealing with our difficult life; “It’s not
me it’s my Bipolar, Depression, OCD, GAD”, or whatever condition we have been
given to justify taking medication. It sometimes makes it easier to explain why
we are not coping. For some, it enables a sense of belonging, almost a cultural
acceptance. But continuing to believe the chemical imbalance theory and taking
drugs we don’t need or understand can have life changing, often irreversible
effects on us physically and psychologically. Just as importantly, blaming our
brain chemistry and convincing us we need medication allows those who should be
improving our social conditions and quality of life, (often the real causes of
our distress), to avoid responsibility. The chemical imbalance theory has been
a political and commercial no-brainer.3
THE UNRECOGNIZED
POWER OF THE PILL
Why don’t we question the potential effects
of taking antidepressants? Why do so many of us take these drugs knowing so
little about the effects they might have on our mind and body?
Antidepressants are psychiatric drugs. They
are psychoactive psychotropic substances. Psychoactive means they affect the
mind, but they do so much more than simply affecting our mind. “A psychoactive
drug or psychotropic substance is a chemical substance that acts primarily upon
the central nervous system where it alters brain function, resulting in temporary
changes in perception, mood, consciousness and behavior.”34 Most of us take antidepressants
without acknowledging or being aware they are powerful psychotropic drugs and
very often without going near psychiatry.
Dr. Candace Pert, the neuroscientist
and pharmacologist whose work was key to the development of SSRI
antidepressants spoke out against them in October 1997 in TIME magazine. “I am
alarmed at the monster that Johns Hopkins neuroscientist Solomon Snyder and I
created when we discovered the simple binding assay for drug receptors 25 years
ago. The public is being misinformed about the precision of these selective
serotonin-uptake inhibitors when the medical profession oversimplifies their
action in the brain.”35
In a 1996 paper, the National
Institute of Mental Health (NIMH) director Stephen Hyman described how
psychiatric medication works, “The drugs are better understood as agents that
create abnormalities in brain function. Psychotropic drugs, all perturb normal
neurotransmitter activity in the brain. The brain, however, has various
feedback mechanisms to monitor its neurotransmitter activity, and in response
to the drug’s perturbation of its normal functioning, it goes through a series
of “compensatory adaptations.” The brain is seeking to maintain its normal
functioning. The immediate molecular targets of these drugs in the nervous
system initiate perturbations that activate homeostatic mechanisms... until
cellular signaling reaches an adapted state which may be qualitatively and
quantitatively different from the normal state.”36
The shocking fact is,
antidepressants do not cure our non-existing chemical imbalance, they actually
create one and this imbalance can affect us mentally and physically. Just like
other substances that affect brain chemistry (such as illicit drugs),
psychiatric drugs produce altered mental states. They do not “cure” diseases,
and in many cases their mechanism of action is not properly understood.37
What we do know is they can induce varied and unpredictable mental and physical
states. These drugs work more like substances that temporarily alter our state
of mind, such as caffeine or cannabis. In other words, they don’t cure us they
simply change us. Anecdotal evidence tells us they can throw us temporarily
into a foreign state of mind, into an altered version of who we are which can
result in behavior and personality changes.
In terms of changing us physically,
what most of us don’t realize is antidepressants act directly on the central
nervous system (CNS). They interfere with the functioning of the most basic and
essential autonomic (sympathetic and parasympathetic) nervous systems which
control all our vital functions of the body (digestive, cardiovascular,
respiratory, endocrine, sleep, reproductive, immune and other systems) as well
as affecting moods, feelings and complex human thought processes. We have known
for many years antidepressant neurotoxicity causes neurological problems and
these include movement disorders, seizures, balance and visual issues which are
often diagnosed as Medically Unexplained Symptoms (MUS), Myalgic
Encephalomyelitis (ME), Chronic Fatigue Syndrome (CFS) or Functional
Neurological Disorder (FND).38,39,40
Antidepressants might create serious
altered mental states and physical states so is it worth the risk? Studies have
found that “antidepressants have no clinically significant benefit over placebo
pills in the treatment of mild to moderate depression.”41 For around 85 percent of us,
antidepressants work, on average, no better than placebo pills. This conclusion
has been demonstrated by numerous meta-analyses studies which gathered together
all of the clinical trials which have attempted to assess whether
antidepressants work better than placebo pills. They concluded antidepressants
are no more effective than placebos for most people.42 A further, major meta-analysis
commissioned by the UK NHS, and published in The Lancet, showed the difference
between placebos and antidepressants is so modest, that for mild to moderate
depression antidepressants were not worth having at all. As the lead author of
the study stated: “Our widespread comparative meta-analysis of antidepressants
showed, pretty clearly, that the difference between the published and
unpublished studies of antidepressants in children, was that for the published
trials, all the drugs worked, while for the unpublished trials none of the
drugs worked.”43
Professor Irving Kirsch, Harvard
Medical School, conducted the most noted and perhaps definitive of these
analyses. Kirsch’s meta-analysis included all the major clinical trials of SSRI
antidepressants—both those that were published and the nearly 40% that were
withheld from publication by the pharmaceutical companies who sponsored or
conducted them (the withheld trials largely showed negative results). Kirsch’s
analysis revealed the vast majority of people who took the antidepressant
experienced, on average, no clinically significant improvement over those who
took the placebo. “Antidepressants are supposed to work by fixing a chemical
imbalance, specifically, a lack of serotonin in the brain. Indeed, their
supposed effectiveness is the primary evidence for the chemical imbalance
theory. But analyses of the published data and the unpublished data that were
hidden by drug companies reveals that most (if not all) of the benefits are due
to the placebo effect. Some antidepressants increase serotonin levels, some
decrease it, and some have no effect at all on serotonin. Nevertheless, they
all show the same therapeutic benefit. Even the small statistical difference
between antidepressants and placebos may be an enhanced placebo effect, due to
the fact that most patients and doctors in clinical trials successfully break
blind. The serotonin theory is as close as any theory in the history of science
to having been proved wrong.”44
4
MENTAL HEALTH:
THE BUSINESS
Treating our ‘mental health’ is big
business. The more people diagnosed the more drugs are sold. But who is looking
after the patients’ interests?
If we see our ability to cope with life as
an illness or condition, the drug regulators and pharmaceutical industry see us
as customers. Antidepressants and other medications used in mental health have
become a multi-billion-dollar business. What most of us don’t realize is the
regulators of antidepressants and other psychiatric drugs; the Federal Drug
Agency (FDA) in the US and the Medicines and Healthcare products Regulatory
Agency (MHRA) in the UK, receive significant funding from the pharmaceutical
industry and employ ex-industry professionals in key leadership positions.19
The FDA is often accused of not
putting the American people first. Little surprise when we look at the
donations made to Senate members and the House of Representatives. During the
2017-2018 election campaigns, pharmaceutical companies donated $6,955,960 to
Senate members and $16,823,447 to House of Representative members.20
There is little doubt that the financial ties between pharma and congress are
negatively affecting the health of the US by promoting our ongoing exposure to
sometimes harmful prescription drugs. But this issue is also about a lack of
consumer awareness. The pharmaceutical industry relies on us trusting them and
that we choose to take their drugs. We need to be more aware and try to educate
ourselves as best we can. We need to be in a position where we can make better,
more informed decisions.
In the UK, the MHRA has often been
accused of corruption. The costs it incurs for regulating medicines in the UK
are, as the MHRA states, entirely “met by fees from the pharmaceutical
industry”. In other words, the regulation of all medical drugs in the UK
(psychiatric and otherwise), is entirely funded by the very industry whose
success or failure and most importantly profits, depend upon whether its
products are approved by organizations like the MHRA.21
These conflicts of interest have
been said to lead to lenient regulations placing commercial (pharmaceutical)
interests above patient protection. Most of us will be surprised to hear the
FDA and the MHRA require only two positive clinical trials to approve an
antidepressant for public use. Without any clear scientific justification or
rationale, the FDA and MHRA simply ignore the negative trials. This industry
has a long history of burying negative results, and of manipulating research to
highlight positive outcomes. The majority of psychiatric drug trials are of
course conducted and commissioned by the pharmaceutical industry.
“The MHRA requires only 2 clinical
trials to approve a psychiatric drug for public use, even if there exist 4, 5,
6, or more negative trials. In a practice for which there is no clear
scientific justification or rationale, the MHRA simply discards the negative
trials. This means, in short, that even if 10 negative trials exist, on the
basis of only one or two positive trials the drug can still be approved for
public use.”22
In the UK, The House of Commons
Health Committee has in the past criticized the process by which drugs are
licensed, saying it is far from transparent. Their concerns include the facts
there is no public access to the data presented by the pharmaceutical companies
nor to the assessments undertaken by the MHRA. They say there is not enough
involvement of patients, the public and the wider scientific community, the
agency does not listen or communicate well and denial of access to information
held by the MHRA puts the interests of pharmaceutical companies ahead of those
of patients. “There is evidence that in certain areas, company influence is
excessive and contrary to the public good. A distortion in the balance between
industry and public interests can be seen as inappropriate not by breaching any
law but because the very excess might be a destabilizing influence and put
patients at risk.”23
The latest FDA controversy came in March 2019, when they approved the
antidepressant esketamine, to be marketed under the brand name Spravato, for
treatment-resistant major depression. The FDA gave the pharmaceutical company
Janssen very quick approval for Spravato and, it is reported, quite a bit of
flexibility. Spravato, like the ketamine on which it is based, can have
psychedelic and cognitive adverse effects. The nasal spray can only be
administered in a medical setting and patients must stay at the clinic for at
least two hours after administration.24
In Lancet Psychiatry online, Erick
H. Turner, MD, who is a member of one of the FDA advisory committees which
recommended approval of Spravato said, “the drug did not meet standard criteria
for FDA approval and there was little evidence to support its safety and
efficacy based on data from three short-term phase 3 trials and one withdrawal
trial.” Turner, who is a psychiatrist at Oregon Health and Science University
in Portland, noted, “only one of the three trials that led to the drug’s
approval was positive, and there was a widespread assumption that a
“breakthrough” drug with a novel mechanism of action is more effective than
approved alternatives.” He calls this “breakthrough bias.” He added, “If you
showed them the same data for an SSRI, they would ask, “What’s good about
this?”25
Another expert, Glen Spielmans, PhD,
professor of psychology and antidepressant researcher, Metropolitan State
University, Minnesota, told Medscape Medical News, “Based on the evidence
provided in Janssen’s application, the FDA should not have approved the drug.
The fact that esketamine was superior to placebo to a statistically significant
extent in only one of the short-term trials is unimpressive.”26
What is worrying about this is by
lowering the bar and approving antidepressants “with incredibly questionable
safety and efficacy,” the FDA is once again putting patients at risk. Any new
antidepressants, from now on, may or may not “meet standard criteria for FDA
approval” and yet they might still be approved! Time will tell, but this might
prove to be just one more example of the FDA not putting the American people
first.
Again, this book does
not contain medical advice. Use this book to understand what
antidepressants are and their possible benefits and risks, which include the
many “side”/adverse effects. It is important to remember there is a real chance
we might become dependent on antidepressants.
WARNING: There are
many reasons why it is important we never stop taking or start withdrawing from
antidepressants or other psychotropic medication without the support of a
knowledgeable medical professional or support service. Antidepressant treatment
should be supported by frequent reviews. We need to be aware, from the very
first pill we take, of any physical or psychological changes we experience and
report them immediately to our prescriber. Evidence suggests the risk of
suicide, self-harm or other severe adverse events is significantly higher when
commencing, stopping or changing doses or switching drugs including generics.
PART 2
The Power of the
Informed Patient
5
ALTERNATIVES WORTH
CONSIDERING
Life can be difficult, but the question is:
Might our situation change? Might we simply feel better with time?
We have all become used to our ability to
cope with our life being regarded as our “mental health”. The reality is, we
are, most of the time simply being human and reacting to everyday life events
the way we as humans might be expected to. It is natural to be sad after a
death, feel lost after a relationship breakup, anxious when we lose our job or
feel traumatized after a major adverse experience. It is often difficult and
painful but our emotions and reactions to our life are what make us who we are.
If we are finding life difficult to
cope with, we might decide to visit a doctor or psychiatrist. If they are
sensible and realistic, they might ask us to wait a while before we consider
taking medication.45
It would probably be worth taking their advice. A lot of the time we will start
to feel better if we wait, even if to us it seems like the more difficult
option. Life can be fast moving, ever changing, and the way we are feeling is
probably a reaction to an aspect of our present life, however painful it might
be. Former psychiatrist Dean Schuyler wrote in his 1974 book that most
depressive episodes “will run their course and terminate with virtually
complete recovery without specific intervention.”46
Nowadays we are all told to be more
open about our mental health. We are encouraged by governments, charities and
celebrities to tell our “stories” about our mental state. The media bombard us
with messages that our mental health is no different to our physical health; that
they deserve parity, and we deserve help.
If we think about it rationally, we
can often work out the real issues in our lives causing our sadness, anxiety,
grief or distress. With the right support and a little time our feelings and
life events, traumas, stresses and worries will probably pass, and we will
learn from our experience. Life’s ups and downs make us who we are and help us
build our character. A lot of the time these events strengthen our ability to
respond to future life events, however challenging they might be.
In 2006, Michael Posternak, a
psychiatrist at Brown University studied what untreated major depression might
look like today. His findings showed that old epidemiological studies were not
so inaccurate at all and considered why six-week trials of drugs had been
misleading. He reported that 22% of non-medicated patients recovered after one
month; 67% within six months; and 85% within a year. He wrote, “If as many as
85% of depressed individuals who go without somatic treatment spontaneously
recover within one year, it would be extremely difficult for any intervention
to demonstrate a superior result to this.”47,48
When we are finding life tough, we
might consider asking for help but that doesn’t always have to be professional
help. We could talk to family, friends or a work colleague about how we feel
about our life. We can share as much or as little as we need to. Most
importantly we can ask them to listen to how we are feeling without them being
judgmental or offering advice. This is not a conversation about our “mental
health” but one about our life and things we might be struggling with or
finding difficult. It is a great place to start.
Not everyone has someone to talk
with or wants to share their feelings with people they know. We could ask to be
referred for psychological therapy or counselling. It might not feel “like me”
to ask for this kind of help but we might be surprised how much it can help us
deal with the underlying causes of our emotional distress. The reality is it
probably won’t change the life situation we find our self in, but it might help
us look at and cope with things differently.
There are many alternatives to consider
before we turn to medication. Lifestyle improvements including our diet, sleep,
drinking less alcohol and reducing screen time (in particular the time we spend
on social media), can all have a positive effect on how we feel. Increasing
exercise has proven positive benefits on our mental state. Spending time
reading, gardening, with a pet, or taking up a new hobby can be effective ways
to deal with anxiety or low mood. Everyone’s situation is different, and we
have to acknowledge not everyone is in a situation where we can turn to these
alternatives. But it is important to remember that a life without
antidepressants is an option and life well worth considering.
6
BEING INFORMED
ABOUT
OUR TREATMENT OPTIONS
It is about being as informed as we can be
and asking about our treatment options.
The Nation Institute for Mental Health
(NIMH) advise; “Treatment for mental illnesses usually consists of therapy,
medication or a combination of the two. Treatment can be given in person or
through a phone or computer (telehealth). It can sometimes be difficult to know
where to start when looking for mental health care, but there are many ways to
find a provider who will meet your needs.”49
For low level depression, guidelines
suggest an initial course of psychosocial therapy like guided self-help or
physical activity and for low level to moderate depression, a high-intensity
psychological therapy is recommended. If we are experiencing moderate to severe
depression, guidance indicates antidepressants can be prescribed with a
high-intensity psychological therapy. Guidance also suggests antidepressants
can be used for people with low level to moderate depression if psychosocial
and psychological treatments have not worked.
The suggestion is we should already
have received psychological therapy or have been referred for psychological
therapy prior to antidepressants being prescribed. The reality is there are
many reasons we might not be offered therapy. Unfortunately, a large percentage
of us have no access to psychosocial support or psychological therapy as
services to refer people to often don’t exist or have long waiting times.
Antidepressants are all too readily used as first-line treatment, with no other
options discussed.
It is not easy, but we should always
try to be as involved as we can be in planning and making decisions about our
health care. When discussing treatment, it is important we make decisions with
our doctor and that they listen to our opinions. Doctors should not make
decisions about our treatment without asking how we feel and without informing
us of our treatment options and their benefits and risks. It is important to
remember we have the right to ask questions.
We need to be as prepared as we can
be before attending an appointment. Having our views respected and having the
opportunity and time to make a decision is our right and we owe it to ourselves
to be as informed as we can be. If we make choices about our own treatment, we
are more likely to benefit from it. Many of us do not want to take
antidepressants, but we do know we need some kind of help. Our doctor should
always give us the information and advice to enable us to get the best and most
appropriate treatment available.
Using this book and being more
informed about antidepressants can make us feel more confident about being
involved in making decisions about our treatment. Where possible we should try
to include our family or someone close to us when we are thinking about taking
antidepressants. We can often have symptoms which might prevent us making fully
informed decisions and, if this is the case, it is important to take someone
with us to appointments and have their support. They can ask questions on our
behalf and try to get honest answers. We do not have to make a decision about
antidepressants at our first appointment or even immediately after receiving a
prescription. We could take some time, use this book to help with our decision,
talk to others who have experience of taking them, weigh up our options and
decide what is best for us.
7
THE IMPORTANCE OF
INFORMED CONSENT
Are we being fully informed when we are
prescribed antidepressants? Why does this area of medicine seem to ignore
“informed consent”?
In nearly all other areas of medicine (such
as surgery, medical tests and procedures), a patient’s informed consent is
required prior to treatment. This means a prescriber must explain the treatment
so that we can decide if the treatment is right for us. We should be in a
position where we can make educated decisions and informed choices, with our
prescriber, about what is best for us. Informed consent
means we understand why, based on our diagnosis, the treatment is being offered
and we are aware of the benefits and risks. Only then should we agree to
the treatment. Informed consent is our medical right.
Rather than informed consent,
antidepressant prescribing has sometimes been described as being based on
“manufactured consent”. This implies we are being manipulated into supporting
what others want us to support but we believe we are forming our opinion using
our own free will. Whether it be “manufactured” or “implied” consent, anything
other than informed consent is unacceptable when being prescribed mind-altering
antidepressants.
“Why has the American public not
heard psychiatrists in positions of influence on the mass media debunking the
chemical imbalance theory? Big Pharma’s corruption of psychiatry is only part
of the explanation. Many psychiatrists, acting in the manner of a benevolent
elite, did not alert the general public because they believed that the chemical
imbalance theory was a useful fiction to get patients to accept their mental
illness and take their medication. In other words, the chemical imbalance
theory was an excellent way to manufacture consent.”50
Wendy Ratcliffe and Lynn Cunningham,
directors of the documentary, “Medicating Normal,”51 a film showing the experiences
of people harmed by taking psychiatric medication, want psychiatrists and
doctors to require informed consent for all psychiatric drug prescriptions.
“The problem, Ratcliffe says, is that psychiatry lobbying groups feel that
informed consent impedes their ability to prescribe. She compares the industry
to the NRA: any criticism is treated as a potential keystone that, if removed,
will take out the entire system. In reality, all patients are asking for is
honesty about how these drugs interact in their bodies. We don’t know the
long-term effects because pharmaceutical companies don’t have to study them. If
the industry isn’t required to disclose these effects, and psychiatrists remain
ignorant of the real damage being done to some of their patients, informed
consent remains an intangible dream with no pathway to reality.”52
A 2012 University of Massachusetts
Boston study concluded, “Clinicians today practice in a time-limited,
pharmaceutical-industry dominated climate in which reductive biological models
are heavily promoted. Such models reinforce an acontextual view of patients’
problems and a disease-rather than patient-centered model of care. As a result,
“diagnosis by checklist” (Andreasen, 2007) becomes a primary source of
automatic prescribing (Cosgrove & Bursztajn, 2007). Thus, genuine informed
consent requires, first and foremost, that mental health professionals adopt a
mindful approach to psychiatric taxonomy and be aware not only of the uses, but
also the limitations of and alternatives to psychopharmacological
interventions. Respecting patient autonomy requires that clinicians be aware of
the marketing practices and biases that may distort their appraisal of the
relative risks and benefits of medications such as antidepressants, and
moreover that they consider the ways in which people can be manipulated by
social constructions of normalcy and health in an industry-dominated climate
(see e.g., Ells, 2003). This increasingly complex network of considerations
presents distinct challenges for clinicians, but dynamic informed consent
processes offer a way to acknowledge the uncertainty associated with
antidepressants while simultaneously empowering patients in their recovery from
illness.”
To enable informed consent, doctors
would have to confront some uncomfortable issues which include many of the
questionable beliefs on which their prescribing is based; the unproven chemical
imbalance theory, the huge risks, the lack of scientific evidence. They would
have to explain to us that we might find we are taking antidepressants in the
long term, that there is a lack of evidence to support this practice and there
are no protocols to help us withdraw if we become dependent.
“Given the drug commercial propaganda
onslaught, for the American people to become aware of the truth, psychiatrists
in positions of influence would have had to zealously publicize that the
research had rejected the chemical imbalance theory, and they would have had to
use the mass media to proclaim that the drug commercials are false.”53
Requiring informed consent when
prescribing antidepressants would undoubtedly change prescribing habits.
Informed consent would also mean we need answers to the many questions about
the evidence on which antidepressants are currently prescribed. Some doctors do
make sure their patients are fully informed, but for the foreseeable future at
least, the best we can do is educate ourselves and those we care about.
In our quick fix world, three minutes is
all it might take to be diagnosed “mentally ill”.
Millions have been diagnosed as having
depression or anxiety using the questionnaires PHQ-9 and GAD-7. These were
designed to enable doctors to recognize depression disorders and anxiety
disorders. Adopted as standard measures, these screening tools set a very low
threshold for what can be diagnosed as mental illness according to DSM
criteria. They can take less than three minutes to complete. Our responses to
these questions often result in a pharmaceutical company’s questionnaire and a
doctor’s subjective decision determining whether or not we are mentally ill and
which treatment and label we receive.
The copyright for the PHQ-9 was
formerly held with Pfizer Pharmaceuticals. They provided the educational grant
for the design of the questionnaire. They no longer hold the copyright and no
permission is required to reproduce, translate, display or distribute the
PHQ-9. Of course, the more doctors use the questionnaires, the more
antidepressants and other psychotropic drugs are sold. Pfizer are the makers of
the SSRI antidepressant Zoloft (sertraline), the SNRI antidepressant Effexor
(venlafaxine).
8
KNOWING
ANTIDEPRESSANT
BENEFITS AND RISKS
If we are thinking about taking
antidepressants, we need to look at the benefits and risks. We need to be aware
of the lack of scientific evidence on which antidepressant prescribing is
based.
It is important to remember that
antidepressants can be prescribed for a wide range of problems. They are used
to treat anxiety, insomnia, pain, smoking cessation, premenstrual syndrome,
panic disorders, fibromyalgia, migraine, obsessive-compulsive disorders, and a
host of other “off-label” conditions for which the drugs are not even approved.
Since they were introduced, the
benefits of antidepressants have been widely promoted and the risks generally
downplayed. We read so many times that if we have been diagnosed and prescribed
antidepressants, “it’s just like taking medicine for a physical condition” and
they are simply “another treatment option to help you get better.” This is
grossly oversimplified and is in many cases untrue.
Everyone has an individual, unique
response to antidepressants and even though there are some very common
experiences when first starting to take them, no one can predict how we will
react to them physically and psychologically. During the first few weeks some
of the adverse effects we might experience are: nausea, insomnia, increased
anxiety, restlessness, dizziness, weight gain, dry mouth, sweating, upset
stomach, headaches, agitation, loss of appetite and decreased sex drive,
amongst others.
A doctor should always give us
comprehensive information when prescribing antidepressants allowing for fully
informed decision making. We might be told “antidepressants take four to six
weeks to work.” We also often hear, “It is completely normal for
antidepressants to make you feel worse before you feel better” and that our
bodies and minds are “adjusting to a new medication”. But are we adjusting to
the drugs or, as Stephen Hyman wrote, are antidepressants making changes to our
brains and how we function?55
Are the changes the first signs of dependence and the beginning of our new
“antidepressed” drug-induced normal?
If we have unpleasant side or
adverse effects after the first two weeks, we might go back to our prescriber.
We might be switched from one antidepressant to another until we find the one
that best suits us. We might be told that finding the right antidepressant is a
process of trial and error, but it might simply be that eventually the
antidepressants create our new “qualitatively and quantitatively different”
balanced state. We simply don’t know. We are told “the efficacy of the
different antidepressants is largely equivalent,” so perhaps we might trust our
doctor to find us the one which has the least adverse effects until we get used
to these changes?
Actual positive response rates to
antidepressants are much lower in studies with “real-world” patients compared
to industry-funded trials. In a study of 118 real-world outpatients, only 19%
of the patients had responded to an antidepressant after three months, which is
a much lower response rate than is usually seen in the industry-funded trials.
The NIMH funded a large study, known as the STAR*D study, to assess the
effectiveness of antidepressants in real-world patients, and even though
patients were given up to four courses of treatment with different
antidepressants, only 38% ever responded positively to the treatment.56
It is important to note the Patient
Information Leaflets accompanying antidepressants state, “the side effects
depend on the dose and often disappear or lessen with continued treatment”; the
pharmaceutical companies would of course prefer we continue taking our
medication.
Adverse effects might lessen or
disappear simply because we get used to the drug’s actions and the changes, but
it could be at the expense of many aspects of our life and health being
detrimentally affected. The most significant being becoming dependent on the
medication.
After a few weeks of taking
antidepressants many of us decide they are not for us and look for other ways
to help. For others it can seem like antidepressants have been lifesaving and
it can become difficult to imagine surviving without them. The reality might be
that with or without the medication, things in our life might simply have
changed, improved, moved on, got better and in the meantime, we have started a
life where “difficulty surviving without antidepressants” has actually become a
physical and psychological reality.
If we choose to start taking
antidepressants, we must have frequent reviews with our prescriber. If we
choose to take an antidepressant, we must be aware of any physical and
psychological changes. At any time during treatment, we need to note these and
report them to our prescriber. It is our right to ask questions and be an
informed patient. Having thoughts of suicide, self-harm or violence are linked
to starting antidepressant treatment. In 2004, the US Food and Drug
Administration, (FDA) issued a black box warning—the agency’s strictest
warning—for all SSRI antidepressants regarding their association with suicidal
thoughts and behaviors. It is for this reason it is vital, if possible, we let
someone close to us know if we start taking antidepressants. They can monitor
any changes in our behavior and personality which we might not recognize
ourselves. Any changes should be immediately reported to our prescriber.
A doctor or psychiatrist should give us
comprehensive information when prescribing antidepressants enabling us to make
fully informed decisions. Unfortunately, we know this does not always happen.
According to Realistic Medicine in the UK,
one of the ways forward is “Choosing Wisely”, a set of question prompts which
some National Health Service (NHS) Scotland boards are encouraging people to
ask about their health care.
1.
Is this test, treatment or procedure really
needed?
2.
What are the potential benefits and risks?
3.
What are the possible side effects?
4.
Are there simpler, safer or alternative
treatment options?
5.
What would happen if I did nothing?57
Preparing for an appointment with our
doctor:
·
Before going to an appointment, we should
think about and write down any questions we have.
·
Write down our symptoms, how we are feeling
and our main concerns. Try to remember how long we have had any symptoms, their
severity and how they have changed over time.
·
Take a list of any medications we are
currently taking, including both prescription and over-the-counter medications
and any supplements /vitamins. This should include the dose and how often we
take them.
·
During the appointment take notes we can
refer back to later.
·
It is particularly important to discuss any
psychological therapy / counselling we have had or antidepressants we have
taken in the past.
·
Take a note of any other medical conditions
we have.
·
If we do not feel confident or comfortable
asking questions, it might be useful to ask a relative or friend to go with us
to our appointment. Tell them how we are feeling before the appointment and the
questions we need to ask.
Some questions we might want to ask about
our treatment:
·
Why do you think I am feeling the way I am?
·
Why do you think I should take
antidepressants and what are their benefits?
·
Are there other options to antidepressants-such
as ‘social prescribing’ and/or psychotherapy/counselling -and can you give me
information on what is available to me?
·
If I decide to take an antidepressant,
which would you prescribe and why?
·
Is this antidepressant approved to help me?
·
How would I take the medication?
·
What happens if I were to miss a dose?
·
What are the adverse effects and what
should I do if I have any?
·
How soon will the antidepressants work?
·
What do I need to avoid while on this
medication?
·
How long will I need to be on this
medication?
·
Can I become addicted to or dependent on
antidepressants?
·
Can I stop taking this medication when I
feel better?
·
Will I get help when I decide to stop
taking them?
·
What should I be doing in addition to
taking medication?
·
Should I let a relative or friend know I
have started this medication?
·
Antidepressant prescribing is based on
scientific evidence... isn’t it?
The American Psychiatric Association’s
(APA) website Practice Guidelines says they “provide evidence-based
recommendations for the assessment and treatment of psychiatric disorders.”
They claim their guidelines are evidence-based practice but actually have only
three current and up-to-date guidelines available.
“The APA developed and published 23
practice guidelines from 1992 to 2010, including multiple second and third
editions. Thirteen of the guidelines are available in this section. These
guidelines are more than 5 years old and have not yet been updated to ensure
that they reflect current knowledge and practice. In accordance with national
standards, including those of the Agency for Healthcare Research and Quality’s
National Guideline Clearinghouse, these guidelines can no longer be assumed to
be current.”58
Prescribing is the area most
affected by evidence-based medicine, “the conscientious, explicit, and
judicious use of current best evidence in making decisions about the care of
individual patients.”59
Few other areas of medical practice have felt the effects of this movement more
than prescribing of medicines. If governments and medical bodies claim they are
implementing evidence-based prescribing for antidepressants then they should be
expected to back up their decisions with evidence and this should rely on
honest data, clinical expertise and patients’ values and preferences. All this
should result in the safer and more effective use of antidepressants.
The UK Royal College of
Psychiatrists 2019 position statement on antidepressants and depression states,
“It is worth noting that a challenge in prescribing antidepressants is that the
available research does not inform clinicians about whether an individual
patient will benefit from antidepressant use, to what extent, and which type of
antidepressant should be tried first. Clinicians therefore need to use their
judgement, training, and experience in discussing and agreeing the best
approach with patients and/or their family/care providers.”60
Unfortunately, it is all too
apparent that, based on the current evidence available, the claims that
antidepressants and other drugs used in mental health work and are safe is very
questionable. There have been only a few other medications that have had such
large numbers of double-blinded, placebo-controlled trials performed to
demonstrate they work and gain regulatory approval. There have been over a
thousand antidepressant randomized trials and statistically significant
benefits have been repeatedly demonstrated. The medical profession and patients
found this evidence reassuring and few questions were asked.
Despite all of this, the truth is
unfavorable trials are frequently left unpublished and remain unavailable to
doctors and patients. This is a process of selective publication and
study-designs are often manipulated and industry-sponsored studies are
incomplete, biased and in favor of their product. It is a fact that most
intervention studies are industry sponsored. The medical profession and the
public are often being misled, and this means patients can be given less
effective, harmful or more expensive treatments.
Contrary to what we have been told and what
most of us believe, the genuine antidepressant “evidence-based” facts include:
·
There are no known biological causes for
any of the mental health disorders apart from dementia and some rare
chromosomal disorders.
·
Mental health diagnostic systems lack
validity.
·
No chemical imbalances have been proven to
exist in relation to any mental health disorder.
·
Antidepressants do not ‘cure’ diseases, and
in many cases their mechanism of action is not properly understood.
·
Psychiatric drugs cause altered mental
states.
·
Studies have found that antidepressants
have no clinically significant benefits over placebo pills in the treatment of
mild to moderate depression.
·
Negative effects are often misdiagnosed.
·
There has been little research on the
long-term outcomes of people taking antidepressants and they can have effects
including mental disturbance, suicide, violence, and withdrawal syndromes.
·
The majority of psychiatric drug trials are
conducted and commissioned by the pharmaceutical industry or those who have
extensive ties with them. This industry has a long history of burying negative
results, and of manipulating research to highlight positive outcomes.
·
Withdrawal from antidepressants can be
disabling and cause severe physical and psychological effects which often last
for months and sometimes years, sometimes leading to suicide.
More information on these facts can be
found at “Unrecognized Facts” published by the UK Council for Evidence-Based
Psychiatry.61
Off-label prescribing...when there is no
evidence at all!
We might be surprised to learn a large
percentage of antidepressants are prescribed off-label. Off-label prescribing
is when an FDA-approved medication is prescribed for an unapproved condition or
in different way from that approved by the FDA. The prescribing of medications
in this manner is definitely not supported by scientific evidence.
“From the FDA perspective, once the
FDA approves a drug, healthcare providers generally may prescribe the drug for
an unapproved use when they judge that it is medically appropriate for their
patient. You may be asking yourself why your healthcare provider would want to
prescribe a drug to treat a disease or medical condition that the drug is not
approved for. One reason is that there might not be an approved drug to treat
your disease or medical condition. Another is that you may have tried all
approved treatments without seeing any benefits. In situations like these, you
and your healthcare provider may talk about using an approved drug for an
unapproved use to treat your disease or medical condition.”62
Investigators at McGill University,
in Montreal, Canada, found that 45% of the antidepressants prescribed for more
than 100,000 adults living in the province of Quebec were for conditions other
than depression. Furthermore, almost one third of these prescriptions were for
an off-label indication, most commonly, insomnia and pain. “Researchers want to
assess the safety and effectiveness of different antidepressants, but one of
the main problems standing in the way of that is that physicians are
prescribing antidepressants for so many different indications now, not just
depression.”63
“The off-label use of prescription drugs was associated with a 44% increase in
the risk of adverse drug events and an even greater risk, 54%, when the
off-label use was not backed by strong scientific evidence. Off-label
prescribing is common, with one US study finding that about a fifth of doctors’
prescriptions were for off-label use.”64
There is an urgent need to produce
more evidence of the risks and benefits of off-label antidepressant use and a
need for improved monitoring and evaluating of off-label use. Off-label
prescribing can put us at risk of adverse effects and unknown health risks
which could be avoided. Of particular concern is the growing rate of off-label
prescribing of antidepressants to children and young adults. As patients we
need to know if we are being prescribed antidepressants off-label and we should
always ask the question, “Is this medication approved to treat my condition?”
It is important we ask why we are being prescribed antidepressants if they have
not been approved to treat us. It is just one more area of antidepressant
prescribing where we can be at the mercy of the subjective “medical judgement”
and the scientifically unfounded opinion of our doctor.
9
THE MANY ADVERSE
EFFECTS
INCLUDING AKATHISIA
Antidepressants might have no clinically significant
benefit over placebos, but these licensed and widely prescribed medications can
cause serious adverse effects.
It is misguided to believe the “placebo
effect” is justification for taking antidepressants. Rather than being inert,
we know they can induce varied and unpredictable physical and mental states.65
They are not a cure for any mental health condition, and the adverse effects of
these drugs can be serious and sometimes even fatal, making the description of
these drugs as “working at placebo-level” misleading and unrealistic.
Antidepressants disrupt the function of key neurotransmitters which play
important roles throughout the main communications systems of both our brain
and body, a fact often ignored or denied by prescribers.
“The public is being misinformed
about the precision of these selective serotonin-uptake inhibitors when the
medical profession oversimplifies their action in the brain and ignores the
body as if it exists merely to carry the head around! In short, these molecules
of emotion regulate every aspect of our physiology.”66
In some cases, antidepressants can
create health problems we did not have prior to taking the medication and their
benefits are limited. Recent research and the ever-growing body of anecdotal
evidence confirms the seriousness of antidepressant adverse effects. It is
impossible to list every adverse effect we might suffer when taking an
antidepressant. How they affect us as an individual is unique to us. For some,
adverse effects can happen at recommended dose levels and when taken short
term, and for others it can be dependent on the dose or on which antidepressant
we are prescribed.
Common adverse effects of
antidepressants include central nervous system problems, sexual problems,
weight gain, digestive problems, debilitating fatigue and numbed emotions, as
well as other confusing and little understood symptoms. It is now blatantly
obvious these so called “side effects” contribute significantly to other
health, relationship, social and economic issues, and increasingly to the
national burden of chronic ill-health and disability rates.
A 2018 study concluded, “Asking
people directly reveals far higher rates of adverse responses to
antidepressants than previously understood, especially in the emotional,
psychological and interpersonal domains. Given recent findings that
antidepressants are only marginally more effective than placebo, the findings
of the current study imply a cost-benefit analysis that cannot justify the
extremely high prescription rates for these drugs.”67 The online survey asked
antidepressant users whether they had experienced 20 adverse effects and to
what degree of severity. The survey included 1,431 people, from 38 countries.68
PERCENTAGES OF 1,431 ANTIDEPRESSANT USERS WHO REPORTED
EACH ADVERSE EFFECT |
|
Feeling emotionally numb |
70.6% |
Feeling foggy or detached |
70.0% |
Feeling not like myself |
66.2% |
Sexual difficulties |
66.1% |
Drowsiness |
62.7% |
Reduction in positive feelings |
60.4% |
Weight gain |
60.1% |
Dry mouth |
59.3% |
Distorted dreams |
59.2% |
Withdrawal effects |
58.9% |
PERCENTAGES OF 1,431 ANTIDEPRESSANT USERS WHO REPORTED
EACH ADVERSE EFFECT |
|
Agitation |
58.0% |
Insomnia |
57.7% |
Caring less about others |
54.5% |
Dizziness |
51.6% |
Headaches |
50.4% |
Suicidality |
50.3% |
Doctors are prescribing these powerful
drugs as “safe and effective”, but they can have complex neurological effects
some prescribers do not seem to want to understand or acknowledge. When we
report symptoms, we can often be disbelieved and discounted by doctors. We can
also fail to realize ourselves that it is our medication, “taken as
prescribed”, which is causing the symptoms we are experiencing. It is common
for doctors to add more medications to deal with what are antidepressant
adverse effects. This can result in polypharmacy and further complications.
It is crucial we recognize any changes we
experience when taking antidepressants, particularly when starting, withdrawing
from them or changing dose. Any adverse effects or changes must be reported to
our prescriber. It is important we ask the question “could my antidepressant be
causing my problems?” and we do not simply assume our doctor knows all the side
/adverse effects of the drugs we take.
In the Washington Post article, “Doctors
often don’t tell you about drug side effects, and that’s a problem,” Adriane
Fugh-Berman, professor in the Department of Pharmacology and Physiology at
Georgetown University Medical Center says, “Patients need to become their own
experts, researching drugs on websites—such as the government database
MedlinePlus69,70—that
are free of [the pharmaceutical] industry. Doctors have a responsibility to
listen to their patients about side effects, too, she said. I tell medical
students: If a patient develops a symptom after they’ve gone on their drug,
it’s always the drug’s fault until proven otherwise. We’re in sort of a bad
situation now where the people in control of prescribing drugs know the least
about the drugs.”71
So that we can provide informed
consent, our doctors should inform us of the possible adverse effects before we
agree to take antidepressants. But to protect ourselves, we need to ask
questions. We need to ask ourselves, do antidepressants balance a non-existent
chemical brain imbalance or is there the potential they might actually create
disturbing brain and body imbalances? We need to be aware the harmful and
life-changing adverse effects of antidepressants experienced by some patients
point to the latter.
Some of the more common “adverse” or “side”
effects of antidepressants include:
·
Gastrointestinal effects, such as nausea,
diarrhea, dyspepsia, GI bleeding and abdominal pain
·
Hepatotoxicity and hypersensitivity
reactions; liver toxicity, fever and rash
·
Weight problems and metabolic disturbances;
weight gain, anorexia
·
Cardiovascular effects, such as heart rate
variability leading to cardiovascular events
·
Genitourinary ailments like urinary
retention, incontinence
·
Sexual dysfunction, reductions in libido,
arousal dysfunction
·
Hyponatremia; salt imbalance
·
Osteoporosis/bone weakening, risk of
fractures, loss of muscle strength fatigue
·
Abnormal bleeding and bruising
·
Nervous system dysfunction: akathisia
followed by dystonic reactions, parkinsonian movements and tardive dyskinesia,
headaches, tremors, numbness, tingling, burning
·
Sweating
·
Sleep disturbances: somnolence or
sleepiness/insomnia
·
Affective disturbances; mood change,
emotional blunting, anxiety, agitation, panic attacks, insomnia, irritability,
hostility, aggressiveness insomnia, impulsivity
·
Overdose toxicity
·
Withdrawal Syndrome: flu-like symptoms,
tremors, tachycardia, shock-like sensations, paresthesia, myalgia, tinnitus,
neuralgia, ataxia, vertigo, sexual dysfunction, sleep disturbances, vivid
dreams, nausea, vomiting, diarrhea, worsening anxiety and mood instability,
mania, psychosis
·
Ophthalmic effects: glaucoma, cataracts,
blurred/double vision
·
Hyperprolactinemia; increases in peripheral
prolactin levels
·
Hormonal imbalance
·
Risks during pregnancy and breast feeding,
birth defects
·
Risk of malignancies; growth of
fibrosarcoma and melanoma
·
Serotonin Syndrome
·
Suicidality72
A Patient Information Leaflet (PIL) for
sertraline (very similar to the PIL for other SSRI/SNRI antidepressants) lists
over fifty possible “side effects” which they
describe as very common or common. In addition, there are over one hundred and
forty which they describe as uncommon or rare. It explains side effects “often
disappear or lessen with continued treatment.” It is now recognized it is
misleading for “drug dependence” to be listed as a rare side effect.
PACKAGE
LEAFLET: INFORMATION FOR THE USER
Sertraline 50 mg & 100 mg film-coated
Tablets Sertraline hydrochloride73
Like all medicines, this medicine can cause
side effects, although not everybody gets them. Nausea is the most common side
effect. The side effects depend on the dose and often disappear or lessen with
continued treatment.
Tell your doctor immediately if you
experience any of the following symptoms after taking this medicine, these
symptoms can be serious.
·
If you develop a severe skin rash that
causes blistering (erythema multiforme); this can affect the mouth and tongue.
These may be signs of a condition known as Stevens Johnson Syndrome, or Toxic
Epidermal Necrolysis (TEN).
Your doctor will stop treatment in these
cases:
·
Allergic reaction or allergy which may
include symptoms such as itchy skin rash, breathing problems, wheezing, swollen
eyelids, face or lips.
·
If you experience agitation, confusion,
diarrhea, high temperature and blood pressure, excessive sweating and rapid
heartbeat. These are symptoms of Serotonin Syndrome. In rare cases this syndrome
may occur when you are taking certain medicines at the same time as sertraline.
·
Your doctor may wish to stop your treatment
if you develop yellow skin and eyes which may mean liver damage.
·
If you experience depressive symptoms with
ideas of harming or killing yourself (suicidal thoughts).
·
If you start to get feelings of
restlessness and are not able to sit or stand still after you start to take
Sertraline film-coated Tablets. You should tell your doctor if you start to
feel restless.
·
If you have a fit (seizure).
·
If you have a manic episode (see section 2,
“Warnings and precautions”).
The following side effects were seen in
clinical trials in adults and after marketing.
Very common (may affect more than 1 in 10
people):
·
Insomnia
·
Dizziness
·
Sleepiness
·
Headache Diarrhea
·
Feeling sick
·
Dry mouth
·
Ejaculation failure
·
Fatigue
Common (may affect up to 1 in 10 people):
·
Chest cold, sore throat, runny nose
·
Decreased appetite, increased appetite
·
Anxiety, depression, agitation, decreased
sexual interest, nervousness, feeling strange, nightmare, teeth grinding
·
Shaking, muscular movement problems (such
as moving a lot, tense muscles, difficulty walking and stiffness, spasms and
involuntary movements of muscles), numbness and tingling, muscle tense, lack of
attention, abnormal taste
·
Visual disturbance, ringing in ears
·
Palpitations, hot flush, yawning
·
Upset stomach, constipation, abdominal
pain, vomiting, gas
·
Increased sweating, rash, back pain, joint
pain, muscle pain
·
Menstrual irregularities, erectile
dysfunction
·
Malaise, chest pain, weakness, fever
·
Weight increases
·
Injury
Uncommon (may affect up to 1 in 100
people):
·
Gastroenteritis, ear infection
·
Tumor
·
Hypersensitivity, seasonal allergy
·
Low thyroid hormones
·
Suicidal thoughts, suicidal behavior*,
psychotic disorder, thinking abnormal, lack of caring, hallucinations,
aggression, euphoric mood, paranoia
·
Amnesia, decreased feeling, involuntary
muscle contractions, passing out, moving a lot, migraine, convulsion, dizziness
while standing up, abnormal coordination, speech disorder
·
Enlarged pupils, ear pain, fast heartbeat,
heart problem
·
Bleeding problems (such as stomach
bleeding)*, high blood pressure, flushing, blood in urine
·
Shortness of breath, nosebleed, breathing
difficult, possible wheezing
·
Tarry stools, tooth disorder, inflammation
of the esophagus, tongue problem, hemorrhoids, increased saliva, difficulty
swallowing, burping, tongue disorder
·
Eye swelling, hives, hair loss, itching,
purple spots on skin, skin problems with blisters, dry skin, face oedema, cold
sweat
·
Osteoarthritis, muscle twitching, muscle
cramps*, muscular weakness
·
Increase in frequency of urination, problem
urinating, unable to urinate, urinary incontinence, increase in urination,
nighttime urination
·
Sexual dysfunction, excessive vaginal
bleeding, vaginal hemorrhage female sexual dysfunction
·
Swelling in legs, chills, difficulty
walking, thirst
·
Increase in liver enzyme levels, weight
decreased
·
Cases of suicidal ideation and suicidal
behaviors have been reported during sertraline therapy or rarely after treatment
discontinuation (see section 2).
Rare (may affect up to 1 in 1,000
people):
·
Diverticulitis, swollen lymph glands,
decrease in clotting cells*, decrease in white blood cells*
·
High cholesterol, problems controlling
blood sugar levels (diabetes), low blood sugar, increase in blood sugar
levels*, low blood salt*
·
Physical symptoms due to stress or
emotions, terrifying abnormal dreams, drug dependence, sleep walking, premature
ejaculation
·
Coma, abnormal movements, difficulty
moving, increased sensation, sudden severe headache (which may be a sign of a
serious condition known as reversible cerebral vasoconstriction syndrome
(rcvs))*, sensory disturbance
·
Spots in front of the eyes, glaucoma,
double vision, light hurts eye, blood in the eye, unequal sized pupils, vision
abnormal*, tear problems
·
Heart attack, light-headedness, fainting,
or chest discomfort which could be signs of changes in the electrical activity
(seen on electrocardiogram) or abnormal rhythm of the heart*, slow heartbeat
·
Poor circulation of arms and legs
·
Breathing fast, progressive scarring of
lung tissue (interstitial lung disease)1, closing up of throat, difficulty
talking, breathing slow, hiccups
·
Mouth ulceration, pancreatitis*, blood in
stool, tongue ulceration, sore mouth
·
Problems with liver function, serious liver
function problems*, yellow skin and eyes (jaundice)
·
Skin reaction to sun*, skin oedema*, hair
texture abnormal, skin odor abnormal, hair rash
·
Breakdown of muscle tissue*, bone disorder
Urinary hesitation, decreased urination
·
Breast discharge, dry vaginal area, genital
discharge, red painful penis and foreskin, breast enlargement, prolonged
erection
·
Hernia, drug tolerance decreased
·
Increase in blood cholesterol levels,
abnormal laboratory tests*, semen abnormal, problems with clotting*
·
Relaxation of blood vessels procedure
Not known; i.e. frequency cannot be
estimated from the available data:
·
Lock jaw*
·
Bedwetting*
·
Partial loss of vision
Additional side effects in children and
adolescents
In clinical trials with children and
adolescents, the side effects were generally similar to adults (see above). The
most common side effects in children and adolescents were headache, insomnia,
diarrhea and feeling sick.
Symptoms that can occur when treatment is
discontinued
If you suddenly stop taking this medicine
you may experience side effects such as dizziness, numbness, sleep
disturbances, agitation or anxiety, headaches, feeling sick, being sick and
shaking (see section 3 “If you stop taking Sertraline film-coated Tablets”).
An increased risk of bone fractures has
been observed in patients taking this type of medicine.
RxISK has a side effect checker. It can be
very useful to take the RxISK report to our prescriber and discuss any side
effects we are experiencing.
Experiencing a Drug Side Effect? Get
your free RxISK Report to find out at www.Rxisk.org
All prescription drugs can cause
side effects, but it can often be difficult to engage with your doctor when
your treatment might be causing a problem.
The RxISK Report takes 10 minutes to
complete and provides you with a RxISK Score indicating how likely it is that
your problem is caused by a prescription drug.
It can also help identify problems
caused by stopping a drug—for example, withdrawal side effects.
If something is going wrong with
your treatment, bringing a RxISK Report to your doctor as early as possible may
be the difference between successful treatment and long-term disability or
death.
No personally identifiable
information is required—only your email address so that we can send you a
printable PDF that you can take to your doctor.
The RxISK Report is designed to:
·
Provide you with a RxISK Score to help
determine whether your problem (or that of someone you care for) is linked to
treatment.
·
Inform and support a conversation with your
doctor.
·
Help our researchers improve drug safety
with anonymized data.
* Side effect reported after marketing
“Akathisia”: the one adverse effect of
antidepressants we all need to be aware of.
“Akathisia is an extremely distressing
neuropsychiatric syndrome characterized by severe agitation, inability to
remain still, and an overwhelming sense of terror. It is primarily a medication
side effect. People with this condition can quickly become suicidal and even
homicidal. Akathisia is far more common than has been reported in the past and
remains dangerously under-diagnosed and under-reported today.”75
Akathisia is a medication-induced
state and is mostly caused by antidepressants, antipsychotics, benzodiazepines,
antibiotics, and anti-nausea medication. Akathisia is often described as the
epitome of losing our mind, with our mind being taken over by uncontrollable
and unrecognizable thoughts. It can happen when our minds become unbalanced due
to starting, stopping or changing dose of certain medication or switching
medication. It can cause terrifying symptoms, often confused with psychosis,
which can also include intense physical restlessness and agitation often with a
need for constant movement. It causes an inner turmoil with severe dysphoria
(anxiety and agitation), manifesting as an overwhelming sense of terror. It can
cause suicidal and violent impulses. Many people diagnosed with first episode
psychosis are actually suffering from prescribed drug-induced akathisia.
“Akathisia is an emotional state
caused by over 100 different drugs, primarily antidepressants and
antipsychotics, but also antibiotics, anti-hypertensives and others. It causes
suicidality, homicidality and other disturbances of behavior.76 It can range from a constant
and disturbing mental unease through to an intense emotional turmoil—and mental
restlessness. This can be accompanied by physical discomfort, an inability to
remain still, or an obvious motor restlessness or fidgetiness. The problems
caused by treatment can in many cases be worse than the illness being treated.77
It may start within an hour of a first pill or only appear after days, weeks or
months. It may only start when the dose of the drug is increased or decreased,
or the drug is stopped. Akathisia is often misleadingly described as a movement
disorder.”
There are four types of akathisia. Each
depends on when the problem occurs and how long it lasts:
·
Acute akathisia develops
shortly after starting a drug.
·
Tardive akathisia develops
months after starting the drug.
·
Withdrawal
akathisia
occurs when stopping a drug.
·
Chronic akathisia is any
type that lasts for more than six months.78
Education and support for akathisia can be
found online. It is vital we are made aware of and informed about akathisia
when we are first prescribed our medication.79 There is also an urgent need to
educate the medical profession, social care workers and emergency services, so
they can recognize and warn patients of the potential dangers of akathisia.
Akathisia is a cause of both suicide and homicide, and it is time for
governments, suicide prevention organizations and charities to recognize
prescription drug-induced akathisia as a leading cause of suicide around the
world.
Akathisia
101
MISSD is pleased to now offer Akathisia
101. The free, online one-hour continuing education course is open to all who
want to better understand, identify and respond to akathisia. Akathisia 101 is
approved by the National Association of Social Workers for 1 continuing
education contact hour. Healthcare and crisis teams, patients, therapists,
caregivers, doctors, first-responders, drug safety advocates and educators—
everyone can benefit from akathisia awareness. Let’s make Akathisia a household
word (www.missd.co).
Akathisia
Alliance for Education and Research
Akathisia Alliance for Education and
Research has produced an invaluable Comprehensive Guide to Akathisia.
What is Akathisia?
Akathisia is an extremely distressing
neurological disorder characterized by severe agitation, an inability to remain
still, and an overwhelming sense of terror. These symptoms are so tortuous that
it can lead to violence and suicide. Akathisia is primarily caused by
prescribed medications. The most frequent offenders are antipsychotics,
antidepressants, anti-nausea medications, and antibiotics, but it can be caused
by many other medications as well. It is also common in benzodiazepine
withdrawal (e.g., Ativan, Klonopin), especially after long-term use. It most
often occurs when starting, stopping, or changing the dose of a medication, but
it can occur at any time during treatment and even months after it is
discontinued. Akathisia is far more common than has been reported in the past
and remains dangerously under-diagnosed and under-reported today.
Symptoms
The following common symptoms of akathisia
have been reported universally (regardless of whether it was caused by
long-term use of a psychiatric medication or by one dose of a non-psychiatric
medication):
·
Intense physical restlessness with a need
for constant movement such as pacing, rocking, foot tapping, hand wringing, and
shifting position in a chair
·
An overwhelming sense of terror, which has
also been described as “chemical terror.” This is so pervasive that the person
actually feels as if they are experiencing a terrifying event such as being lit
on fire or buried alive.
·
A feeling often described as wanting to
“jump out of my skin”
·
Extreme agitation, impatience, and
irritability
·
Suicidal and/or violent impulses
·
Non-suicidal self-harm impulses (e.g.,
hitting, cutting)
·
Depersonalization-derealization (feeling
disconnected from the body, as if observing it from the outside, or a sense
that the world is unreal, similar to living in a dream)
·
Separation anxiety/monophobia and
agoraphobia (a need to be near safe people and places at all times due to the
terror)
·
Racing thoughts and pressured speech
·
Vocal tics (e.g., throat clearing,
grunting)
·
Subjective physical sensations such as
electrical zaps, buzzing, vibrating, burning, bugs crawling under the skin,
etc.
·
Hypersensitivity to light and sound
·
Executive dysfunction (impulsivity,
disorganization, inattention, emotional dysregulation)
Recognizing
Akathisia (ICD-10-CM Code G25.71)
Key Points
·
Akathisia is a neurological disorder
composed of both neurological and psychological symptoms.
·
Motor symptoms can be variable, briefly
suppressed, increase with attention, and decrease with distraction.
·
Motor symptoms may increase with physical
and/or psychological distress.
·
Excessive movements are not always evident.
·
Due to the above-noted motor characteristics,
akathisia can easily be misdiagnosed as a functional neurological disorder.
Clinical
Assessment
There is no consensus regarding which
movements, if any, are characteristic of akathisia. In our study, the features
that best discriminated akathisia from non-akathisia were 1) shifting weight
from foot to foot, or walking on the spot, 2) inability to keep legs still
(subjectively), 3) feelings of inner restlessness, and 4) shifting of body
position in the chair. However, these features are not present in every
patient, and in the milder cases, only the subjective report may be present, at
least on brief examination, and only prolonged observation will reveal any
motor disorder. Voluntary movements and effortful tasks tend to reduce the
movements. The majority of the patients report that akathisic movements are
voluntary and in response to subjective distress.
Except for the most severe cases,
patients are able to voluntarily suppress the movements at least for short
periods. Another feature of the movements is their marked variability over
time, and their usual disappearance during sleep. Tremor of the extremities is
not uncommonly associated, and this may be regarded as the co-occurrence of
drug-induced parkinsonism.
Misdiagnosis
and Suicidality
Akathisia is not subtle. Its symptoms are
so severe, in fact, that there are many reports of people with no history of
mental illness or depression who took their lives within days of its onset. The
importance of an accurate and swift diagnosis cannot be stressed enough. As the
suicidality is primarily due to its subjective symptoms, it is crucial to
consider a self-diagnosis—even when a patient exhibits no objective signs.
Failure to do so and an alternate misdiagnosis are currently resulting in
unnecessary involuntary hospitalizations, forced drugging with medications that
worsen the akathisia, loss of family support, abandonment, homelessness, and a
much greater risk of suicide.
Common
misdiagnoses: Worsening of a mental illness, new mental illness,
generalized anxiety disorder, panic disorder, personality disorder, bipolar
disorder, attention-deficit/hyperactivity disorder, restless legs syndrome,
health anxiety
Functional
neurological, somatic symptom, and factitious disorders: Patients
with symptoms severe enough to cause suicidality may easily meet the criteria
for these disorders until they find a doctor who recognizes their akathisia.
They will appear to have disproportionate and persistent thoughts about the
seriousness of their symptoms, have a persistently high level of anxiety about
their symptoms, and spend excessive time devoted to these symptoms. They will
do their own research, know the correct medical terms, be eager to have
numerous tests performed, and have a history of visiting many doctors and hospitals.
Drug-seeking: Akathisia
is very common in benzodiazepine withdrawal, especially if prescribed long
term. It can also occur with tolerance and between doses. To these patients,
even one missed dose can cause significant worsening. Due to the increased suicidality,
they know they may not survive a cold-turkey withdrawal. They are not
drug-seeking to get high. They simply need their prescription renewed so they
can taper at a rate slow enough to prevent a return of the akathisia.
Treating
Akathisia
Pharmacological treatment of akathisia is
extremely difficult because a medication that helps one patient may harm
another. Please consult the literature for suggested treatment options. If a
patient is tapering off a psychotropic medication, it is crucial to continue
their tapering schedule. A faster taper can result in a return, or severe
worsening, of their akathisia.
Note: Threatening to restrain and/or
force drug patients exhibiting signs of akathisia, including self-harm, could
significantly worsen their condition. Using a calm tone to assure them they are
safe may be much more effective.
The following dopamine-depleting
medications can cause or significantly worsen akathisia:
·
aripiprazole (Abilify)
·
asenapine (Saphris)
·
cariprazine (Vraylar)
·
chlorpromazine (Thorazine)
·
ciprofloxacin (Cipro)
·
citalopram (Celexa)
·
clozapine (Clozaril)
·
delafloxacin (Baxdela)
·
desvenlafaxine (Pristiq)
·
domperidone (Motilium)
·
doxycycline
·
droperidol (lnapsine)
·
duloxetine (Cymbalta)
·
escitalopram (Lexapro)
·
fluoxetine (Prozac)
·
fluphenazine (Modecate)
·
flupentixol (Fluanxol)
·
gemifloxacin (Factive)
·
haloperidol (Haldol)
·
iloperidone (Fanapt)
·
levofloxacin (Levaquin)
·
levomilnacipran (Fetzima)
·
loxapine (Loxitane)
·
lurasidone (Latuda)
·
metoclopramide (Reglan)
·
milnacipran (Savella)
·
moxifloxacin (Avelox)
·
ofloxacin (Floxin)
·
olanzapine (Zyprexa)
·
paliperidone (lnvega)
·
paroxetine (Paxil)
·
perphenazine (Trilafon)
·
pimozide (Orap)
·
prochlorperazine (Compazine)
·
promethazine (Phenergan)
·
quetiapine (Seroquel)
·
risperidone (Risperdal)
·
sertraline (Zoloft)
·
thiothixene (Navane)
·
tiapride (Tiapridal)
·
trifluoperazine (Stelazine)
·
trimethobenzamide (Tigan)
·
venlafaxine (Effexor)
·
ziprasidone (Geodon)
·
zuclopenthixol (Clopixol)
Anosognosia or Medication Spellbinding
Personality changes are an adverse effect
we might fail to recognize when we are taking antidepressants. This is called
“Anosognosia” or “medication spellbinding”. The following is how Peter Breggin,
psychiatrist and author, describes it, “First, the individuals fail to perceive
that they are acting in an irrational, uncharacteristic and dangerous manner.
Second, they fail to identify the medication as playing any role in their
drastically changed mental processes and activities. Third, they often think
that the medication is “helping”, although sometimes they believe it’s
ineffective, and they continue to take it as they deteriorate mentally. In the
extreme, individuals suffering from medication-induced mania and psychosis
believe that the drug is helping greatly and that they are “better than ever”.
Fourth, some spellbound individuals become compulsively violent toward
themselves or others, and commit bizarre acts wholly alien to their prior
personalities.”80
Coming to terms with our
personality, lifestyle or how we behaved whilst taking antidepressants if often
one of the most difficult issues to deal with, especially when withdrawing from
medication. For some, taking antidepressants has resulted in criminal
convictions, relationship breakups, antisocial behavior, financial ruin and
what are deemed to be irreparable lives. These are far from uncommon
experiences.
Serotonin
Syndrome
“Serotonin syndrome” or “serotonin
toxicity” is a drug reaction caused by an accumulation of high levels of
serotonin. It can be caused by interactions between drugs and by taking too
much of the medication or simply when starting, increasing dose or adding a
medication. Antidepressants are amongst many drugs and supplements which can
cause serotonin syndrome.
We know serotonin influences a wide
range of psychological and bodily functions including our central nervous
system, brain, blood platelets and intestines and serotonin syndrome is not
just about serotonin levels in the brain. It can be mild to life threatening.
The main symptoms of serotonin syndrome are agitation or restlessness but can
include: confusion, rapid heart rate and high blood pressure, dilated pupils,
loss of muscle coordination or twitching muscles, muscle rigidity, heavy
sweating, diarrhea, headache, shivering, goose bumps, high fever, seizures,
irregular heartbeat and unconsciousness. Severe serotonin syndrome can be
life-threatening.
“It’s important to stay informed
about your medications. Knowing what you are taking, the active ingredients,
possible side effects, and medications that should not be mixed are important
in avoiding serotonin syndrome. Pay close attention to the instructions of your
medications to ensure you are taking them at correct intervals. If you have
questions about your medications, reach out to your doctor to double check that
you are not mixing medications that could result in serotonin syndrome.”81
Sex
Sexual problems are one of the most
reported adverse effects of antidepressants and are suffered by a significant
number of people. They can cause a wide range of symptoms including, erectile
dysfunction, inability to orgasm, pleasureless orgasm, diminished libido,
genital numbness.
“They should be called anti-sex
drugs rather than antidepressant drugs,” says Jon Jureidini, a child
psychiatrist of 30 years standing, a professor of psychiatry and pediatrics at
the University of Adelaide and co-author of a BMJ study, “It’s more reliably
predictable that they’re going to get rid of sexual function than it is that
they’re going to get rid of depression.” Some people find this persists long
after they cease taking the drug. “Post-SSRI sexual dysfunction (PSSD) is an
iatrogenic condition which can arise following antidepressant use, in which
sexual function does not completely return to normal after the discontinuation
of SSRIs, SNRIs and some tricyclic antidepressants.”82
Manufacturer information about this
is sometimes buried, or misleading. It is believed that many people who take
antidepressants for a significant length of time will be guaranteed to
experience sexual adverse effects. If we realized this, we might not be so
quick to fill our prescription, especially at a young age.
Sexual problems are one of the most
common reasons people would like to stop their medication and this should
always be done with a competent medical professional or support service. Online
advice, such as the following often suggests we can “take a drug holiday” but
this should definitely be avoided.
“Taking a drug holiday. Depending on
how long the drug usually remains in your body, you might stop taking it for a
few days—for example, before a weekend, if that’s when you hope to have sex.
This isn’t spontaneous, but it can work if you carefully follow your doctor’s
directions about how to stop and resume your medication. However, there is
always a chance that this might cause a relapse, especially if it is one of the
drugs that leaves your system relatively rapidly.”83
This is incredibly bad advice and
taking a drug holiday should never be an option. Stopping abruptly at any time
can be dangerous, even if it is “for a few days”! Rather than causing a
“relapse”, our sex-induced antidepressant break could cause life threatening
withdrawal symptoms.
Alcohol
The relationship between alcohol and
antidepressants is unknown. However, we are generally advised not to drink
alcohol with antidepressants as alcohol can make depression worse, increase
anxiety, and cause personality changes. It is thought mixing antidepressants
and alcohol can also lead to worse adverse effects of the medication. Some
report alcohol can even prevent antidepressants working properly. What we do
know is many people who take antidepressants become alcohol dependent or abuse
alcohol. A combination of antidepressants and alcohol can be devastating.
Anecdotal evidence tells us alcohol problems often begin soon after a person
starts to take antidepressants.
The 2014 study “Ninety-three cases
of alcohol dependence following SSRI treatment” looked at reports linking
serotonin reuptake inhibitor use with increased alcohol consumption.
It concluded, “The data make it
clear that all treatments with significant effects on the serotonin reuptake
system are likely to cause this problem. Both sexes, and all ages are affected,
and reports have come from a range of countries. SSRI induced alcoholism is
likely to be a relatively common problem. Recognizing the problem can lead to a
gratifying cure. A failure to recognize it can be fatal.”84
Reports link antidepressants and
cravings for alcohol, in particular paroxetine.85 Experienced with anosognosia,
the effects of alcohol can have devastating effects on our lives. Many of us do
not realize antidepressants are causing our problems with alcohol and the
combination can cause life changing uncharacteristic behavior.
Pregnancy
It has been referred to as a “pre-pregnancy
dilemma” but it is not as simple as do we stay on antidepressants or stop
taking them. If we want to have a baby.86 Without realizing it many young
women will have already become dependent on their antidepressants and may not
be able to stop them if they want to. Those who try due to pregnancy, often do
so unsupervised and without tapering slowly and find themselves with horrendous
withdrawal symptoms. The doctor will say this is a “relapse” and prescribe more
antidepressants! If they try to taper during pregnancy, lasting withdrawal
effects might be confused with postpartum depression. A dilemma indeed!
Women in the US are twice as likely
as men to take antidepressants. “During 2008-2013, approximately 15% of a
convenience sample of reproductive-aged women (aged 15-44 years) with
employer-sponsored insurance filled a prescription for antidepressants. The
most commonly filled antidepressants were sertraline, bupropion, and
citalopram.”87
Taking antidepressants whilst
pregnant is a worrying issue for many. We will probably be told the risks of
not treating depression outweigh the risks of antidepressants to both mother
and baby, but we do know antidepressants can cross the placenta and enter the
amniotic fluid. They can also be found in breastmilk. There is an increasing
amount of compelling evidence that an antidepressant free pregnancy might be
our best option.
Studies show one in every three
babies born to mothers on antidepressants will have mild symptoms which can
include jitteriness, poor feeding, agitation and fast breathing. There is also
a slightly increased risk of Persistent Pulmonary Hypertension (PPHN) in the
newborn. PPHN is a very rare but potentially very serious problem causing
breathing difficulties.88
A 2014 study in Canada, looked at
infants born over a decade. It found a link between women taking SSRI drugs and
an increased risk of autism in their children. “Use of antidepressants,
specifically SSRIs, during the second and/or third trimester increases the risk
of autism spectrum disorder in children, even after considering maternal
depression.”89
A US study reported some birth
defects occur 2-3.5 times more frequently among the infants of women who took
paroxetine or fluoxetine early in pregnancy. The CDC study findings refute some
of the earlier reported links but confirm other links observed between birth
defects and some SSRI antidepressants.
Researchers still observed five out of the
seven previous links between paroxetine and certain birth defects. In the
study, paroxetine appeared to be linked with these birth defects:
·
Anencephaly, a birth defect of a baby’s
brain and skull
·
Atrial septal defects, a type of heart
defect
·
Heart defects with obstruction of the right
ventricular outflow tract
·
Gastroschisis, a birth defect of the
abdominal wall
·
Omphalocele, another type of birth defect
of the abdominal wall
Despite the increased risks for certain
birth defects from some SSRIs found in this study, the actual risk for a birth
defect among babies born to women taking one of these medications is still very
low.90
We should never stop taking
antidepressants suddenly, even if we discover we are pregnant. It is important
we consult our doctor and discuss our options. It is however, one issue which young
women need to think about when they consider taking antidepressants, even if
pregnancy might not be at the forefront of their minds.
Drug
Interactions
“It is important to be aware of common drug
interactions between SSRIs and other medications, especially because some SSRIs
are competitive inhibitors of a variety of cytochrome P450 liver enzymes.
Therefore, they can significantly increase the blood levels of medications that
are metabolized by those liver enzymes. Drug interactions with clinical consequences
usually involve combinations of an SSRI with other psychotropics, especially
monoamine oxidase inhibitors (MAOIs) and tricyclic antidepressants. The
interaction between MAOIs and SSRIs is the most important drug interaction
limiting SSRI use. MAOI’s are infrequently prescribed due to other options
available and the high risk of interaction with other drugs.”91
To avoid serotonin syndrome
antidepressants should not be taken with other drugs which increase serotonin
activity. There are certain other drugs SSRIs should not be mixed with. Amongst
these are the herbal St. John’s wort, monoamine oxidase inhibitors such as
phenelzine (Nardil), and clomipramine (Anafranil), tramadol and meperidine.
Serotonin syndrome has also been reported when an SSRI is combined with
lithium. Sertraline, citalopram and escitalopram have the lowest potential for
drug interactions.
Drug
Interaction Checker
The RxISK website has a drug interaction
checker we can use to check if our antidepressants might interact with other
medication.
This tool, available at
rxisk.org/tools/drug-interaction-checker, uses the following resources provided
by the US National Library of Medicine:
·
ONCHigh is a list of high-priority
drug-drug interactions derived by a panel of experts and contained in a JAMIA
article.
·
DrugBank contains the drug-drug
interactions contained in the DrugBank database.
This interaction checker is not intended as
a substitute for professional medical advice, diagnosis, or treatment.92
10
ANTIDEPRESSANT-INDUCED
SUICIDE
Can antidepressants make us suicidal and
why do suicide prevention experts choose to ignore prescription drug-induced
suicide?
A paradoxical reaction or paradoxical
effect is an effect of medical treatment, usually a drug, opposite to the
effect which would normally be expected. An example of a paradoxical reaction
is suicidal ideation caused by antidepressants. It is now widely acknowledged
that prescription drugs can put us at risk of dangerous adverse effects, most
notably that antidepressants and some other medication can raise the risk of
suicide.
Animal studies demonstrate, when
initially given fluoxetine the brain actually shuts down its own production of
serotonin, causing a paradoxical effect or opposite effect on the level of
serotonin.93
The brain’s chemistry wants to remain balanced and any disruption from SSRIs or
other medications throws the brain off balance. What results from this
disturbance is often described as being like a “rollercoaster effect”. A
person’s mood can go from consistently depressed to temporarily content, to all
over the place very quickly. This is why “Black Box Warnings” are required on
all SSRIs.94
Suicide risk with antidepressants
has previously been falsely reported in pharmaceutical industry trials but
recent research published in the Journal of Psychotherapy and Psychosomatics
reports adults prescribed antidepressants for depression are 2.5 times more
likely to attempt suicide when compared to those taking a placebo. Conducted by
Dr. Michael P. Hengartner, a senior research fellow at the Zurich University of
Applied Sciences and Dr. Martin Plöderl, a senior researcher at Paracelsus
Medical University, Salzburg, the study, “Newer-generation antidepressants and
suicide risk in randomized controlled trials: A re-analysis of the FDA
database” found 1 in every 200 people who start treatment will attempt suicide
due to the effects of the drug.95
They examined all suicides and suicide attempts recorded in the safety
summaries of all antidepressant trials submitted to the US drug regulator FDA,
between 1987 and 2013, for marketing authorization of new antidepressant drugs
for the treatment of adult major depression. In these randomized controlled
clinical trials, the rate of suicide was about three times higher in those taking
antidepressants compared to a placebo, and the rate of non-fatal suicide
attempts and suicides combined was about 2.5 times higher in those taking
antidepressants compared to placebo.
Akathisia, the drug-induced state of
acute physical and psychological agitation, puts patients at risk of suicide in
two ways. Rather than contemplating and planning suicide, akathisia often
presents people with a tortuous fight to stay alive. This severe anxiety,
restlessness, agitation, psychosis-like state can mean we have little control
over our mind and suicidal impulses and thoughts are outside our control. In
other cases, it can be so uncomfortable and so distressing, accompanied by
other severe physical adverse effects that people often turn to suicide as
their only option.
Many akathisia sufferers have called
charities and suicide lines only to be misunderstood and asked, “What is wrong
with you?” These are often people in the high-risk groups; young and
middle-aged men, people in the care of mental health services, people in the
criminal justice system, doctors, nurses, veterans and people with a history of
antidepressant induced self-harm. Nearly always they are people who are
starting, changing dose or withdrawing from psychotropic medication. They are
people suffering from prescription drug reactions and find no help from the
medical profession or from charity help lines.
Admittedly most doctors and
healthcare workers do not understand akathisia and the symptoms of anxiety,
agitation or suicidality are often diagnosed as a recurrence or worsening of
illness, rather than a drug-induced adverse event. Suicide-inducing akathisia,
an adverse reaction to antidepressants and other psychiatric drugs is
overlooked in medical error, willfully ignored by governments and suicide
prevention organizations, and all the while it is an avoidable adverse reaction
of prescribed medication. (Psychiatric drugs are not the only drugs that cause
akathisia. People who take drugs such as anti-emetics (anti-nausea drugs),
antibiotics, antipsychotics and opioids, may also experience akathisia and
become suicidal—people who do not in any way have identifiable psychiatric
disorders).96
Peter Breggin, leading psychiatrist
and medical expert who has examined dozens of cases of individuals who have
died by suicide or committed violent crimes whilst under the influence of SSRIs
says, “certain behaviors are known to be associated with these drugs, including
anxiety, agitation, panic attacks, insomnia, irritability, hostility,
impulsivity, akathisia (severe restlessness), hypomania, and mania. Any of
these adverse effects, including emotional blunting, can cause both suicide and
violence.97
In the US, the national rate of
suicide has risen 33% over the past two decades. A 2016 study reported suicides
and suicide attempts cost $93.5 billion a year, most of it in lost
productivity.98
Decades of research into suicide prevention has been done and there are still
no effective prevention strategies. Little scientific evidence exists that
media campaigns and government strategies reduce suicide and mounting evidence
that they don’t.
Mental health conditions are said to
be “one of several contributors to suicide.” So why are antidepressants and
their paradoxical effects hardly ever mentioned? If governments, charities and
suicide prevention organizations really want to address the issue of suicide, why
do they fail to mention prescription medication as a leading cause and overlook
the opportunity to reduce suicide caused by medicalization? Despite Black Box
Warnings, why does prescription medication, in particular psychiatric drugs,
remain a taboo subject for suicide prevention experts?
Researchers reported on a study of
suicide rates in 76 countries. They found suicides were higher in countries
with mental health legislation. They reported there was a correlation between
higher suicide rates and a higher number of psychiatric beds, psychiatrists and
psychiatric nurses, more mental health training for primary care professionals
and greater spending on mental health as a percentage of total spending on
health in the country. It all points to the medicalization of suicide.101
In 2020, September 10 was designated
Suicide Prevention Day and was piously promoted as an exercise in increased
awareness. Yet if it really were a “piously promoted” Suicide Prevention Day,
there would have been mention in the media of one of the main causes of
suicide: psychiatric medications including SSRI/SNRI antidepressants. These
medications have destroyed many lives. It is well established that they cause
suicidality in some people—people who are not depressed—yet in all the media
hoopla about suicide prevention, these medications taken by millions, are
seemingly irrelevant.
SSRI Stories is a website with over 7,000
stories mentioning antidepressants. Most of them have been published in
newspapers or scientific journals. It seems clear that antidepressants
contributed to the tragic outcomes of the individuals involved. The stories
include violence, suicide, serious adverse reactions, personality changes, etc.
“The media used to know how damaging
these medications can be. Stories from the 1990s on this website prove that.
But after years of marketing of psych meds, and years of lawsuits failing
because of system flaws, the media now go along with the pharma mantra that
antidepressants save lives. There is not a shred of evidence that this is true,
and plenty of evidence that these drugs cause enormous harm. But the press that
supposedly prides itself in unbiased reporting simply chooses not to know.”102
Rather than being presented with the
following article in the New York Times, “Is the Pandemic Sparking Suicide?
Psychiatrists are confronted with an urgent natural experiment, and the outcome
is far from predictable”,103
shouldn’t we be asking “With the alarming increase in psychiatric drug
prescribing, are we confronted with an urgent natural experiment or a medical
trend we are purposely choosing to ignore?”
FDA
Medication Guide: Antidepressants and Suicide
Medication Guide Antidepressant Medicines,
Depression and other Serious Mental Illnesses, and Suicidal Thoughts or Actions
Read the Medication Guide that comes
with you or your family member’s antidepressant medicine. This Medication Guide
is only about the risk of suicidal thoughts and actions with antidepressant
medicines.
Talk to your (or your family member’s)
healthcare provider about:
·
all risks and benefits of treatment with
antidepressant medicines
·
all treatment choices for depression or
other serious mental illness
What is the most important information I
should know about antidepressant medicines, depression and other serious mental
illnesses, and suicidal thoughts or actions?
1.
Antidepressant medicines may increase
suicidal thoughts or actions in some children, teenagers, and young adults
within the first few months of treatment.
2.
Depression and other serious mental
illnesses are the most important causes of suicidal thoughts and actions. Some
people may have a particularly high risk of having suicidal thoughts or
actions. These include people who have (or have a family history of) bipolar
illness (also called manic-depressive illness) or suicidal thoughts or actions.
3.
How can I watch for and try to prevent
suicidal thoughts and actions in myself or a family member?
·
a. Pay close attention to any changes,
especially sudden changes, in mood, behaviors, thoughts, or feelings. This is
very important when an antidepressant medicine is started or when the dose
·
is changed.
·
b. Call the healthcare provider right away
to report new or sudden changes in mood, behavior, thoughts, or feelings.
·
c. Keep all follow-up visits with the
healthcare provider as scheduled. Call the healthcare provider between visits
as needed, especially if you have concerns about symptoms.
Call a healthcare provider right away if
you or your family member has any of the following symptoms, especially if they
are new, worse, or worry you:
·
thoughts about suicide or dying
·
acting on dangerous impulses
·
attempts to commit suicide
·
an extreme increase in activity and new or
worse depression talking (mania)
·
new or worse anxiety
·
other unusual changes in behavior or
feeling very agitated or restless mood
·
panic attacks
·
trouble sleeping (insomnia)
·
new or worse irritability
·
acting aggressive, being angry, or violent
What else do I need to know about
antidepressant medicines?
·
Never stop an antidepressant medicine
without first talking to a healthcare provider. Stopping an antidepressant
medicine suddenly can cause other symptoms.
·
Antidepressants are medicines used to treat
depression and other illnesses. It is important to discuss all the risks of
treating depression and also the risks of not treating it. Patients and their
families or other caregivers should discuss all treatment choices with the
healthcare provider, not just the use of antidepressants.
·
Antidepressant medicines have other side
effects. Talk to the healthcare provider about the side effects of the medicine
prescribed for you or your family member.
·
Antidepressant medicines can interact with
other medicines. Know all of the medicines that you or your family member
takes. Keep a list of all medicines to show the healthcare provider. Do not
start new medicines without first checking with your healthcare provider.
·
Not all antidepressant medicines prescribed
for children are FDA approved for use in children. Talk to your child’s
healthcare provider for more information. This Medication Guide has been
approved by the U.S. Food and Drug Administration for all antidepressants.104
First an antidepressant, then the “side”
effects and then one drug leads to another and another... and another...
“The last thing you want to do is use one
drug to treat the adverse effects of another... initially it might seem to work
but just like any other prescribed medication that causes dependence over time
it will make things exponentially worse.”
In the New York Times article, “The Risks
of the Prescribing Cascade,”105
Jane E. Brody explains, “The problem occurs when drug-induced side effects are
viewed as a new ailment and treated with yet another drug that can cause still
other side effects.” She describes the case of the 87-year old mother of a
pharmacist who was repeatedly misdiagnosed and inappropriately prescribed
medications.
Antidepressants are often gateway
drugs to polypharmacy (being prescribed and taking multiple medications), what
Brody describes as “a costly and often frightening medically induced condition
called “a prescribing cascade” that starts with drug-induced side effects which
are then viewed as a new ailment and treated with yet another drug or drugs
that can cause still other side effects.” With antidepressants it can mean
multiple psychiatric drugs, or any other classes of drug are prescribed, often
off-label, to treat any of the hundreds of adverse effects listed in the
Patient Information Leaflets.
If we consider the number of
possible adverse effects antidepressants can have, it is easy to see why their
risks might be greater than their benefits. Antidepressants affect different
people in different ways, and it is very common for us to become a victim of
polypharmacy if the adverse effects go unrecognized or misdiagnosed as a new
condition. The potential to be prescribed more medication is an important
reason why we need to be savvy and aware of the adverse effects of
antidepressants. Recognizing, making our prescriber aware of, and questioning
our adverse effects can prevent further conditions being diagnosed and more
unnecessary medication added to our drug regimen.
Thankfully, questions are starting
to be asked about prescribers’ knowledge of drug adverse effects and how we,
the patients can educate ourselves. “So I started to wonder: How much knowledge
do doctors have about medications? What can patients do to educate and protect
themselves?”106
It is now recognized doctors might be underreporting to the FDA’s voluntary
Adverse Event Reporting System.
A welcome development is PIMsPlus
which has been developed with the Department of Family Medicine at McMaster
University, the American Society of Consultant Pharmacists, and TaperMD, “to
address the serious problems of polypharmacy, prescribing cascades, and drug
side effects. All of the collaborators contribute to the development and
maintenance of PIMsPLUS at their own expense.”107
It is crucial we avoid unnecessary
medication but unless we become our own experts, we are vulnerable to becoming
a multi-medicated, revolving door patient with pills for every adverse effect
and adverse effects for every pill.
11
ANTIDEPRESSANTS
AND OUR “MEDICALLY
UNEXPLAINED SYMPTOMS”
What happens when our adverse effects are
labelled “Medically Unexplained Symptoms”? Why do so many doctors fail to
recognize antidepressants are causing our symptoms and diagnose additional
conditions and illnesses?
Treatment from our doctors for our mental
health is most likely to be a prescription for antidepressants, which most
believe to be safe and effective, or, at worst, no better than placebo.
However, antidepressants result in homeostatic effects which medically adjust
our serotonin system. These drugs cross the blood-brain barrier and have all
sorts of unintended consequences. “Most serotonin is found outside the central
nervous system, and virtually all of the 15 serotonin receptors are expressed
outside as well as within the brain. Serotonin regulates numerous biological
processes including cardiovascular function, bowel motility, ejaculatory
latency, and bladder control.”108,109
Rather than simply correcting a
serotonin imbalance in our brain, taking antidepressants creates all sorts of
knock-on effects as they mess with serotonin. These are described by Kelly
Brogan in her article, “What’s the harm in taking an antidepressant?” in which
she summarizes the ground-breaking 2016 research, “The Safety, Tolerability and
Risks Associated with the Use of Newer Generation Antidepressant Drugs.”110
Some people are unable to metabolize
antidepressants and may develop adverse reactions which can be serious. These
should, hopefully, be recognized quickly and the drug very gradually reduced
and stopped before more harm is done. As we know, most people will be
encouraged to struggle through the first few weeks of treatment until they
“adjust to” the drug. Many of us can feel emotionally numbed by the drugs—but
also develop physical symptoms such as sexual dysfunction, gut issues, weight
gain, fatigue etc., which can be explained as side effects of the drugs being
taken as prescribed. Unfortunately, many doctors fail to recognize our genuine
physical or psychological symptoms as the adverse effects of antidepressants
and they might tell us we are wrong to put our symptoms down to the
antidepressants we are taking. Others will look for alternative explanations
resulting in a series of examinations and investigations which will generally
produce negative results.
If we see our doctor because of what
we believe might be the adverse effects of antidepressants, it is very common
for doctors to tell us we are suffering “medically unexplained”, somatic or
functional symptoms (MUS). These symptoms, which doctors might describe as “of
unknown etiology” (meaning the cause is unknown), often lead to a diagnosis
such as Chronic Fatigue Syndrome (CFS), Irritable Bowel Syndrome (IBS),
Fibromyalgia or Myalgic Encephalomyelitis (ME). As with our first “mental
illness” diagnosis, there are rarely any investigative tools or tests that can
confirm the presence of these new illnesses. Medically Unexplained Symptoms is,
however, becoming a growing field of research and development as professionals
capitalize on the opportunities the adverse effects of antidepressants present.
Doctors have been trained to
prescribe antidepressants using the PHQ-9 and GAD-7 questionnaires and during
antidepressant treatment they might also use the PHQ-15 questionnaire to
“diagnose” any subsequent developments of new symptoms and suffering as
“psychosomatic”.
Antidepressant withdrawal/discontinuation
symptoms were recognized in the 1990s by researchers using the DESS
(Discontinuation-Emergent Signs and Symptoms scale). In the early 2000s this
list of very debilitating symptoms was divided up and re-branded (with funding
from Pfizer).111
Doctors, psychiatrists,
psychologists and therapists frequently believe patients are “somatising”;
(experiencing psychological distress in the form of physical symptoms), when
many of us are actually suffering the serious physical effects of commonly
prescribed and supposedly safe and effective antidepressants. These effects are
dangerously unrecognized or ignored by prescribers, sometimes with serious
consequences. Doctors can become frustrated when we keep going to see them with
“functional”, “somatic” or “Medically Unexplained Symptoms” (MUS). Medically
Unexplained Symptoms are becoming a growing burden on and are stretching health
service resources.112
In 2013, the American Psychiatric
Association rejected the term “Medically Unexplained Symptoms” in its
Diagnostic and Statistical Manual (DSM-5), replacing it with “somatization” and
“somatic symptom disorder”. This refers to excessive thoughts, feelings, or
behaviors related to somatic (physical) symptoms or health concerns. “We tried
to get away from saying whether the symptoms are explained or not, and just
allow people to have symptoms,” said Michael Sharpe, MD, a University of Oxford
psychiatrist who studies the psychological aspects of medical illness. Dr.
Sharpe was on the DSM-5 work group for somatic symptoms. So, it seems they
decided to “just allow patients to have symptoms” with no reference to the
possibility the symptoms might be the adverse effects of medication. When our
symptoms become severe or chronic, they then become a “disorder”.113
The category “somatic symptom disorder” is for people with severe, chronic and
troublesome physical symptoms that may or may not have a medical explanation.
Medically unexplained symptoms can be classified as a psychiatric disorder and
patients’ symptoms are attributed to their underlying anxiety or depression—or
whatever they may or may not have been suffering when started on
antidepressants. Doctors are failing to recognize that these multiple serious
physical symptoms are actually due to taking or withdrawing from
antidepressants—and this obscures, covers up and misinterprets what is really
happening to people.
It is about so much more than “just
allowing us to have symptoms”, it is about ignoring the adverse effects of
medication and opportunistically classifying them as illnesses. It is, in some
ways, a very similar process to mental health “illness” diagnosis. In the
British Medical Journal (BMJ), Allen Frances warned “the DSM-5 introduces a
poorly tested diagnosis— somatic symptom disorder—which risks mislabeling a
sizeable proportion of the population as mentally ill.”114 Marion Brown, Psychotherapist,
responded in the BMJ, “Something is going horribly wrong when it is becoming
apparent that previously healthy patients are being seriously harmed and made
very unwell by medicines ‘taken as prescribed’-and are then being
dismissed/described as troublesome heartsink patients who display ‘excessive’
responses to distressing, chronic, somatic symptoms with associated
dysfunctional thoughts, feelings, or behaviors. These patients are finding
their medical records and referral letters -and even reports to MHRA -couched
in phrases such as ‘the patient believes,’ and ‘the patient thinks.’ They are
also being labelled with ‘attention seeking behaviors’ and assorted
‘personality disorders’ so as to discount and deny credibility of their very
real experiences and immensely distressing functional symptoms.”115
It is estimated about 1 in 4 people
who see their GP in the UK have Medically Unexplained Symptoms and 1 in 3
patients or more in a neurological outpatient setting. The UK Royal College of
Psychiatrists say, “Other diagnoses can be given for medically unexplained
symptoms, but it is common to use a general term to describe the symptoms, such
as “medically unexplained symptoms.” Another common term is “functional;” i.e.,
the symptoms are due to a problem in the way the body is functioning, even
though the structure of the body is norm.” Amongst their treatment
recommendations are antidepressants, the very source of many medically
unexplained symptoms; “Antidepressants are used to treat a range of problems,
not just depression, and can help treat medically unexplained symptoms in a
number of ways.”116
The Royal College of Psychiatrists do not wish to acknowledge “the problem in
the way the body is functioning” might very well be due to the effects of
antidepressants or other medication the patient might be taking. Their solution
is to recommend prescribing more antidepressants as the answer to relieving the
medically unexplained symptoms they have potentially caused!
If we look at the Patient
Information Leaflet for SSRI and SNRI antidepressants, we will find every
symptom listed on the PHQ-15 is also listed as a possible side effect of
antidepressants! Stomach problems, nausea, joint pain, menstrual problems,
headaches, chest pain, dizziness and fainting, heart palpitations, shortness of
breath sexual problems, tiredness and trouble sleeping are ALL listed as
possible side effects of antidepressants in the Patient Information Leaflets.117
A more realistic representation of
Medically Unexplained Symptoms is shown in Marion Brown’s “A Patient’s journey.
Consequences of Antidepressants/Benzodiazepines”.118
If anything demonstrates “a wicked
problem whose social complexity means that it has no determinable stopping
point” and “because of complex interdependencies the effort to solve one aspect
of the ‘wicked’ problem may reveal or create other problems”, then the industry
created concept of “medically unexplained symptoms” is it!119
12
BECOMING OUR OWN
ANTIDEPRESSANT EXPERT
We need to adopt an approach where one of
the first questions we ask is: “Could it be my medication?” This approach
should also be adopted by everyone who has a responsibility for our health
care.
“Patients need to become their own experts,
researching drugs on websites—such as the government database MedlinePlus— that are ‘free of [the pharmaceutical]
industry. Doctors have a responsibility to listen to their patients about side
effects, too, she said. I tell medical students: If a patient develops a
symptom after they’ve gone on their drug, it’s always the drug’s fault until
proven otherwise. We’re in sort of a bad situation now where the people in
control of prescribing drugs know the least about the drugs.”120
In an ideal world, when it comes to our
health care, we should all try to become our own experts. In the real world,
not everyone is in a position where we can. Learning as much as we can about
our medication and the possible adverse effects is a start. There are many ways
we can do this including books, websites and video links listed in the resource
section of this book.
The FDA advises, “Be an active
member of your health care team. By taking time to learn about the possible
side effects of a drug and working with your health care provider and
pharmacist, you will be better prepared to reduce your chance of experiencing a
side effect or coping with any side effect that you may experience.”121
They encourage side effects to be reported to FDA’s MedWatch, a program for
reporting serious problems with human medical products.122
Back in the real world of adverse
effects, the most useful website is RxISK. Their mission is “Making medicines
safer for all of us.”123
It is owned by Data Based Medicine Americas Ltd. (DBM), based in Toronto and
run by internationally renowned medical experts including Dr. David Healy, Dr.
Dee Mangin, and Dr. Kalman Applbaum.124 RxISK’s goals are educating
and empowering patients to have better conversations about their medications
with their doctors and collecting data on the unintended consequences of
prescription medications so that they can draw attention to them. The website
includes a “Drug search” where we can find out about the adverse effects of our
medication. It includes MedlinePlus Consumer Information (U.S. NLM).125
13
ANTIDEPRESSANT
LONG-TERM EFFECTS
Little research exists on the outcomes of
people taking antidepressants long-term. Might we suffer significantly worse
outcomes if we choose to stay on them?
The National Institute of Mental Health
(NIMH), say people regularly recover from depression without having a second
episode, for example Jonathan Cole in 1964, “Depression is, on the whole, one
of the psychiatric conditions with the best prognosis for eventual recovery,
with or without treatment.” Given this understanding of the natural course of
depression, the NIMH’s experts believed that antidepressants might shorten the
time to recovery, but they wouldn’t be able to boost longterm recovery rates.
In 1974, Dean Schuyler, head of the depression section at the NIMH, explained
that most depressive episodes “will run their course and terminate with
virtually complete recovery without specific intervention.”127 Michael Posternak,
psychiatrist at Brown University wrote, “If as many as 85% of depressed
individuals who go without somatic treatment spontaneously recover within one year,
it would be extremely difficult for any intervention to demonstrate a superior
result to this.”128
“What are the long-term implications
of taking antidepressants? The truth of the matter is that it’s hard to really
know because we don’t do placebo-controlled trials for 20 years. We treat
people and if they’re in a controlled trial, it lasts 12 weeks, maybe 6 months
if you stretch it. How do you sort out the effects of the medication from the
effects of the disease or from the effects of a lot of other things? These are
hard questions to answer.” Dr. John Campo, chair of the department of
Psychiatry and Behavioral Health at The Ohio State University Wexner Medical
Center.129
Doctors rarely warn us about the
long-term effects of antidepressant use and it is something most of us fail to
consider when first starting treatment. There are many of us who have continued
to take antidepressants since the early 1990s and the emergence of SSRIs and
the chemical imbalance theory. There are now many concerns regarding long-term
antidepressant use and the lack of research. The few available studies suggest
all the major antidepressants add little additional longterm benefit, and for
some patients they may lead to significantly worse long-term outcomes. It is
now feared that long-term antidepressant users might be risking permanent
damage to our brains and general health.130
This is definitely one of the
reasons, if we choose to take antidepressants, we should limit the time we take
them to the shortest possible. As people stay on antidepressants longer, we are
seeing some of the effects of the drugs could be permanent. There are emerging
concerns regarding long-term antidepressant use and it is really only from
anecdotal evidence that we are starting to learn some of these effects. We
desperately need ongoing evaluation of antidepressant benefits and their potential
long-term risk of causing certain illnesses. One thing seems certain,
antidepressants and other psychotropic drugs do not reduce the number of
chronically ill patients in society. If antidepressants cure depression, why do
so many of us remain depressed and why do so many who take them have a poor
quality of life?
US science journalist Robert
Whitaker tells us, in “Anatomy of an Epidemic”, the increasing use of drugs not
only keeps patients stuck in the sick role, but also turns many problems that
would have been transient into chronic diseases.131 In Psychology Today, he
describes Giovanna Favas 1994 recently reviewed research, “Can long-term
treatment with antidepressant drugs worsen the course of depression?” Fava
concludes, “There is increasing awareness that, in some cases, long-term use of
antidepressant drugs (AD) may enhance the biochemical vulnerability to
depression and worsen its long-term outcome and symptomatic expression, decreasing
both the likelihood of subsequent response to pharmacological treatment and the
duration of symptom-free periods.”132 In response, Whitaker writes,
“Fava has been banging this drum for 16 years now. One wishes that the NIMH and
American psychiatry would, at long last, address this concern head-on, and
inform the public about it too. But I am not holding my breath.”
A 2016 study took data from an
online survey of 180 people in New Zealand who had taken antidepressants
long-term (3-15 years). Overall, they said they were less depressed and had a
better quality of life because of the drugs, but about 30% still said they had
moderate or severe depression. Many reported concerns over adverse effects; withdrawal
effects (73.5%), sexual problems (71.8%), weight gain (65.3%) and adverse
emotional effects; feeling emotionally numb (64.5%) and addicted (43%.) They
said there needs to be more information about long-term risks.133
A Sky News report warned “Long-term
antidepressant users are risking permanent damage to their bodies, according to
leading medical experts.” Tony Kendrick, a professor of primary care at the
University of Southampton, said, “By the time we find out what the effects of
longterm use are it may be too late to help those people, the effects could be
permanent. If it does cause an increased risk of stroke or seizures or effect
on the kidneys, these things may only come to light as you get older and it may
be very difficult to treat those. We’re seeing some of the longer-term side
effects. Generally, most people are okay on them, but a few people can get
bleeding from the stomach, they can get bleeding in the brain so they get
strokes, they can get epileptic fits.” Interestingly, Kendrick admits
“scientists are not exactly sure how the antidepressants work and therefore
what long-terms effects they might have.”134
In Michael P Hengartner’s 2020
article, “How effective are antidepressants for depression over the long term?
A critical review of relapse prevention trials and the issue of withdrawal
confounding,” he concludes, “This article concurs with a growing number of
physicians and researchers who caution against indiscriminate long-term
antidepressant treatment. Currently, there is no reliable evidence that
long-term antidepressant treatment is beneficial and there are legitimate
concerns that it may be largely ineffective or even harmful in a substantial
portion of users. It is particularly problematic that we have almost no data on
antidepressants’ long-term effects on objective measures of social functioning
(e.g. employment and disability rates) and patient-oriented outcomes such as
quality of life. A critical reappraisal of current treatment guidelines along
these lines is required.”135
Possible Long-Term Effects
Chronic Brain Impairment (CBI)
Antidepressants are neurotoxic. They can
harm the brain and disrupt its functions. They can produce adverse effects on
the structure or function of the central and/or peripheral nervous system. Like
all psychiatric drugs, antidepressants have biochemical effects and other
neurotransmitter systems react to these effects and broader changes can begin
to occur in the brain and in mental functioning over time.
Twenty years ago, in his 2001 paper,
“Psychiatric drug induced Chronic Brain Impairment (CBI): Implications for long
term treatment with Psychiatric Medication,” Peter Breggin describes one
long-term effect as “Chronic Brain Impairment” (CBI). He describes it as being
associated with generalized brain dysfunction manifesting itself in an overall
compromise of mental function. The symptoms include but are not limited to;
cognitive deficits often first noticed as short-term memory dysfunction and
impaired new learning difficulty with attention and concentration, apathy,
indifference (or an overall loss of enjoyment and interest in life activities),
affective dysregulation (including emotional lability), loss of empathy,
increased irritability and finally a lack of self -awareness about these
changes in mental function and behavior.136
He comments, “It is difficult to
estimate what percentage of patients will develop CBI after years of exposure
to psychiatric drugs. In my clinical experience, nearly all patients who remain
on these chemical agents for many years will develop some symptoms of CBI. If
the patient is taking multiple psychiatric drugs for years at a time, in my
experience CBI is always marked.”
Dementia
A 2016 study in Canada concluded,
“Antidepressant drug usage is associated with AD/dementia and this is
particularly evident if usage begins before age 65 and use of antidepressant
drugs was associated with a significant twofold increase in the odds of some
form of cognitive impairment or dementia.”137
A 2018 study published in the
British Medical Journal, found a “robust link” between the degenerative disease
and the medication, even when taken up to 20 years before a diagnosis. It
suggests some patients with long-term exposure to the drugs could face a 30
percent increased chance of dementia.”138
Chris Fox, Professor of Clinical
Psychiatry at UEA’s Norwich Medical School said, “Doctors and patients should
therefore be vigilant about using anticholinergic medications. It is becoming
apparent we need to consider the risk of long-term cognitive effects, as well
as short-term effects when we look at the benefits and risks when considering
taking antidepressants.”139
Diabetes
Studies suggest that long-term
antidepressant use may be associated with an increased risk of type 2 diabetes,
especially for young adults. A study in Taiwan reported; “increasing mean daily
dose or use of selective serotonin reuptake inhibitors or serotonin antagonist
and reuptake inhibitors was associated with increased diabetes risk.”140
A large, population-based cohort
Study in Japan looked at the “Association Between the Use of Antidepressants
and the Risk of Type 2 Diabetes Mellitus.” Its findings were, “Long-term
antidepressant use increased the risk of type 2 diabetes onset in a time-and
dose-dependent manner. Glucose tolerance improved when antidepressants were
discontinued, or the dose was reduced after diabetes onset.”141
Tardive Dysphoria
One of the most concerning potential
long-term adverse effects is tardive dysphoria. It is perhaps unsurprising
worsened depression caused by antidepressants has been given a medical sounding
name. It’s the name given to our state when the drugs might have literally
worsened our depression. It is now believed there is “emerging evidence that,
in some individuals, persistent use of antidepressants may be pro-depressant.”142
It can even occur in some of us who were never depressed but were perhaps
prescribed an antidepressant for one of many other conditions.
It is thought the problem may be
that the “oppositional tolerance” process, means we end up with a depleted
serotonergic system. The postsynaptic neurons end up with a reduced density of
receptors for serotonin. El-Mallakh writes that “a chronic and
treatment-resistant depressive state is proposed to occur in individuals who
are exposed to potent antagonists of serotonin reuptake pumps [i.e., SSRIs] for
prolonged periods. Due to the delay in the onset of this chronic depressive
state, it is labeled tardive dysphoria. Tardive dysphoria manifests as a
chronic dysphoric state that is initially transiently relieved by—but
ultimately becomes unresponsive to—antidepressant medication. Serotonergic
antidepressants may be of particular importance in the development of tardive
dysphoria.” Robert Whitaker asks a very important question; “Many teenagers are
now being prescribed an antidepressant, and when they take the drug, their
brains will develop “oppositional tolerance” to it. What percentage of these
youth will end up with drug-induced tardive dysphoria, and thus suffer a
lifetime of chronic depression?”143
Treatment Resistant Depression
According to Jaskaran Singh, MD, Senior
Director of Neuroscience, Janssen Pharmaceuticals, part of the Johnson &
Johnson family of companies; “Although there is some disagreement as to how to
define treatment-resistant depression, a patient is generally considered to
have it if the individual hasn’t responded to adequate doses of two different
antidepressants taken for a sufficient duration of time, which is usually six
weeks.”144
They believe it exists in up to 30
percent of all patients treated with antidepressants. Along with it can come
suicide ideation, self-harming, functional impairment and relapse. But haven’t
we heard all this somewhere before? Don’t these appear in the list of adverse
effects of antidepressant treatment and withdrawal effects?
“Treatment-resistant depression, a
complex clinical problem caused by multiple risk factors, is targeted by
integrated therapeutic strategies, which include optimization of medications, a
combination of antidepressants, switching of antidepressants, and augmentation
with non-antidepressants, psychosocial and cultural therapies, and somatic
therapies including electroconvulsive therapy, repetitive transcranial magnetic
stimulation, magnetic seizure therapy, deep brain stimulation, transcranial
direct current stimulation, and vagus nerve stimulation.”145
So, a complex clinical problem,
perhaps caused by antidepressants not only requires more treatment with drugs
but also other dangerous and potentially life crippling treatments such as
electroconvulsive therapy (ECT). A classic example of where our initial
treatment with antidepressants, for a mild and self-limiting bout of sadness,
might eventually lead us.
Tolerance
The medical profession admits that another
poorly understood area is why some of us report our antidepressants have
stopped working, sometimes referred to as “poop out” or tachyphylaxis.
“Patients affected by ADT
tachyphylaxis experience a noticeably sudden progressive decrease in response
to SSRIs. The reported rates of this condition vary from 9% to 33% of SSRI
users, and the majority of those affected seem to be less responsive to
subsequent treatments. In most observational studies, these individuals suffer
a recurrence or relapse of depression without changing the previously effective
dose.”146
So called antidepressant tolerance
usually results in our doctor providing a new prescription. “When confronted
with the possibility that an antidepressant may have lost its effectiveness,
the clinician has one of four options. The first option, and one usually
followed by most clinicians, is to increase the dose of the antidepressant,
which may produce a return of effectiveness. Problems associated with this
option include the emergence of side effects and increase in cost. Moreover,
the improvement of most patients with this management strategy is transient so
that subsequent augmentation or change to a different class of antidepressant
is needed.”147
Rather than our new “antidepressed”
unbalanced/balanced state no longer working, could it be, just like the first
time we were prescribed our medication, we are once again simply being human
and reacting to new everyday life events the way we as humans might be expected
to? It is important to remember antidepressants are not a vaccine to shield us
from the trials and tribulations of everyday life. Antidepressants might help
us cope with life in the short-term, but the term “tolerance” is yet one more example
of a situation when we will be further medicated, dose might reach the maximum
which can be prescribed, and additional drugs might be introduced leading to
polypharmacy.
14
DEPENDENCE AND OUR
NEW BALANCED STATE
No one knows how long it takes to become
“dependent” on antidepressants but there are millions of us unaware we are.
Being dependent on antidepressants means we
need the drugs to function physically and mentally in what has become our new
“antidepressed” normal state and we need to maintain the levels of the
antidepressant in our system to stay in our new “normal”. Any reduction or
changes to our antidepressant regimen can induce physical and mental adverse
effects. The antidepressants we have taken to supposedly cure a chemical
imbalance have instead created their own balanced state which, without them, it
is impossible to maintain.148
Dependence is not addiction. According to
the National Institute on Drug Abuse (NIDA), “Addiction is defined as a
chronic, relapsing disorder characterized by compulsive drug seeking, continued
use despite harmful consequences, and long-lasting changes in the brain. It is
considered both a complex brain disorder and a mental illness. Addiction is the
most severe form of a full spectrum of substance use disorders, and is a
medical illness caused by repeated misuse of a substance or substances.”149
If we are dependent, we do not crave antidepressants, there is no drug seeking
behavior, urge to “use”, and taking them does not usually have an effect on our
ability to function socially.
No one knows exactly how long it
takes to become dependent on antidepressants. There are many variables
involved. Regardless of the time we have taken the drug, there is no test to
show how dependent or “unbalanced” we might or might not be. The brain and body
get used to the psychoactive drug and just like when we started taking it, if
we reduce or stop, imbalances can occur. After taking antidepressants for a
prolonged period of time we know that missing just one dose can often cause
problems such as dizziness, brain zaps and feelings of sickness. It can be one
of the first indications we might be dependent.
Many have taken antidepressants
since the 1990s. It is important to remember that for a long time there was no
online information or support groups, and what we knew about the drugs was
limited. Dependence on antidepressants is now a significant public health issue
as more of us become long-term users.
“Long-term use of antidepressants is
surging in the United States, according to a new analysis of federal data by
The New York Times. Some 15.5 million Americans have been taking the
medications for at least five years. The rate has almost doubled since 2010,
and more than tripled since 2000. Nearly 25 million adults have been on
antidepressants for at least two years, a 60 percent increase since 2010. The
drugs have helped millions of people ease depression and anxiety and are widely
regarded as milestones in psychiatric treatment. Many, perhaps most people,
stop the medications without significant trouble. But the rise in long time use
is also the result of an unanticipated and growing problem: Many who try to
quit say they cannot because of withdrawal symptoms they were never warned
about.”150
The truth is that many people find
it difficult to withdraw from antidepressants because of their withdrawal
symptoms caused by dependence. The more dependent we are, the more withdrawal
symptoms we might suffer and the more difficult it might be for us to stop
taking them.
Dependence along with lack of
understanding of the issue of withdrawal and lack of knowledgeable support mean
more of us are choosing to remain blissfully ignorant dependents.
The medical profession is becoming
aware antidepressant dependence is an issue it needs to address but there are
many confusing and mixed messages regarding antidepressant dependence. It is becoming
such a problem that in the UK the British Medical Association (BMA) have
recommended a number of actions be taken to help address the issue. They
recognize the need for a national 24-hour helpline to support people with
prescribed drug dependence. There are a handful of support services in the UK
that might be able to help but the BMA is calling for a national approach to
support, which would allow doctors to refer patients to support in their local
area.151
There are millions of people who are
unaware of the problems that dependence might cause them. Doctors should make
us aware of possible dependence when we are considering taking antidepressants
and it is one of the most important factors in our informed consent. Anecdotal
evidence now tells us it probably doesn’t take very long to become dependent
and it is one of the main reasons, if we choose to take antidepressants, we
should stay on them for the shortest time possible. As soon as we start to feel
better it is time to consider reducing and withdrawing with the help of a
doctor. When and if we should come off antidepressants is a personal choice
requiring serious thought for serious reasons, our potential dependence being
one of them.
Dependence on antidepressants can make us vulnerable.
Being vulnerable when we take
antidepressants is rarely talked about. Being dependent on antidepressants can
make us vulnerable for many reasons. Imagine, after years of taking a drug as
prescribed, we suddenly find we are without it, unable to access it, or in a
position where we are unable to communicate the vital need to have our
medication. If we are without our medication we will inevitably go into
involuntary withdrawal, often with horrendous consequences.
If we are uneducated and not
informed about our medication, we are vulnerable. Prescribers should make us
aware of the benefits and risks of antidepressants. Unfortunately, this is not
always the case. It can be up to us to inform ourselves, to the best of our
ability, about our need to keep ourselves as safe as we can when we take
antidepressants.
This is particularly important for
the elderly and those who find themselves without personal support. Having
access to the drugs which have caused dependence can literally be the
difference between life and death. Finding ourselves in a position where we are
no longer able to make our own decisions about our medication can result in
medications being both unnecessarily deprescribed or overprescribed.
A medicated child or young person
will eventually move away from home and the security of their parent, care
provider or local doctor/prescriber. If they are not educated about the dangers
of suddenly stopping taking their medication and their potential dependence, this
might result in illness, further mental health issues or in some cases suicide.
Millions in the US don’t take their
medications due to the cost. Drugs can cost up to three times more than in the
rest of the world.152
With antidepressants, it is more complicated than simply “if we stop taking
them, they just stop working.” Skipping doses or stopping antidepressants cold
turkey can be fatal. If we think we might be dependent on antidepressants, we need
to regard them as essential. We cannot suddenly stop antidepressants without
some risks. Being unable to afford antidepressants and where to access low-cost
treatments generates much online discussion and often unreliable advice.
This is concerning, as it affects
millions of Americans.
“An estimated one in 10 Americans is
struggling to afford coverage and medications, and about 16 percent of
Americans take a psychiatric medication. That means somewhere between 2.5 to 5
million people are having trouble accessing the psychiatric medications they
need. Even under normal circumstances, such a sudden lack would be a public
health crisis. But the pandemic, as Montgomery pointed out, is triggering in
itself. During March, the Disaster Distress Helpline, a government-run
counseling hotline, witnessed a 338 percent increase in call volume compared to
February.”153
Drug shortages can leave us
vulnerable to the adverse effects of sudden discontinuation of an antidepressant
or having to switch to a different antidepressant. There are already reports of
patients suffering self-harm and suicidal ideation due to drug shortages. One
news report from Canada writes, “The effects of the first shortage [were]
extremely devastating. During that month, I had chronic suicidal ideation, I
barely ate, I was unable to leave home and work. It basically compromised my
whole immune system. It has cost me my income, relationships, it even sent me
to the hospital because of my panic attacks.”154
We are becoming increasingly aware
helplines and charities do not understand or fail to recognize the adverse or
withdrawal effects of antidepressants. They are often told not to discuss
antidepressants with those who need help and ignore the fact that suddenly
being without antidepressants can be a red flag warning for potential suicide.
Some organizations’ reliance on funding from the pharmaceutical industry has
been questioned as the reason for their silence.
Antidepressant dependence needs to
be regarded as a pre-existing condition; after all, it is iatrogenic harm and
caused by the medication which has been legally prescribed.
15
WITHDRAWAL:
THE RELAPSE TRAP
AND RESEARCH
Blaming withdrawal effects on “relapse” has
resulted in millions taking antidepressants long-term.
Scientific research has long suggested that
the reduction or discontinuation, both gradual and abrupt, of antidepressants
determines the appearance of withdrawal symptoms. Usually the patient
interprets (and unfortunately also many clinicians) these symptoms as a
recurrence of the disease following therapy reduction. On the contrary, this
phenomenon has been described in the scientific literature as caused by the
abstinence from SSRI (Selective Serotonin Reuptake Inhibitor) antidepressants
or SNRI (Serotonin and Noradrenaline Reuptake Inhibitor) antidepressants.155
The first time we might become aware
of our inability to cope without our antidepressants is probably when we miss a
dose or when we begin to taper / reduce too quickly. We are probably
experiencing symptoms indicating we have some degree of dependence. Doctors,
however, will probably tell us our symptoms are due to “relapse” and we need
our antidepressants! The terms “relapse” and “discontinuation syndrome” are
convenient terms adopted by the medical profession to keep us taking our
medication and as evidence we need our antidepressants.
Dr. Giovanni Fava, a leading
researcher of adverse effects of antidepressants explained in Psychiatric Times, “If you teach a psychiatric resident
that symptoms that occur during tapering cannot be due to withdrawal they are
likely to interpret [the symptoms] as signs of relapse and to go back to
treatment—exactly what ‘Big Pharma’ likes. The term “discontinuation syndrome”
applied to antidepressants, versus “withdrawal syndromes” compared with
benzodiazepines, was a very smart method of the pharmaceutical industry to deny
the problem.”156
We are told antidepressants prevent
relapse, but Michael Hengartner writes “the argument that antidepressants are
useful for preventing relapse comes “almost exclusively” from “discontinuation
trials.” In these studies, people who respond well to antidepressants are
randomly assigned to two groups: one group remains on the drug, and the other
abruptly stop taking the drug.”157
Christopher Lane, Ph.D. author and
teacher of medical humanities and the history of medicine at Northwestern
University writes, “When patients try to end treatment, even stepping down
their dose very gradually, many of them (22% to 78%, according to Rosenbaum and
Fava158)
find that the receptors in their serotonergic system—saturated artificially for
months, even years—experience the drop to pre-drug levels as starvation. Some
patients then find themselves at the mercy of hair-trigger symptoms that
register as intense anxiety, aggression, and insomnia.
“As the proportion of SSRI-takers
found to suffer from discontinuation syndrome is, by pharmacological standards,
astronomical, and “one in 10 Americans”—roughly 30 million people in the U.S.
alone— “ingests” the drugs each year, as Peter Kramer noted only last week,159
it seems incredible that clinical trials have been so slow to recognize, and
isolate for, withdrawal syndrome in patients trying to taper and end SSRI
treatment. The number of people affected would, in any normal situation, drive
a lot more targeted research on the problem.”
However, while drug-companies have
done their best to redefine withdrawal syndrome as relapse, to confuse doctors
and patients into thinking the original depression or anxiety had returned, the
good news is that research is starting to focus exclusively on the widespread
problem of SSRI withdrawal syndrome.160
“When antidepressant treatment is
started, future discontinuation, including the risk for relapse—as well as
discontinuation symptoms—should be discussed. Based on the author’s experience,
this discussion seldom takes place, although it could affect patients’
decisions regarding treatment options (cognitive behavior therapy vs
medication).”161
Why is the issue of antidepressant
withdrawal, hardly ever discussed when we are first prescribed antidepressants?
Do prescribers purposely avoid the issue they seem to know so little about or
do they think if we were initially told about withdrawal symptoms we might
think differently about taking them?
It would be very rare for
antidepressant withdrawal symptoms to be exactly the same as the original
symptoms we were suffering when we received our initial prescription. If we
think about why we first started taking antidepressants, what was happening in
our life then and how we felt, it is probably pretty easy to see that missing a
few doses of antidepressants or a failed attempt at withdrawal is not a
relapse. How can we suddenly have miraculously returned to our original or a
similar “condition?” It is very common for doctors to tell us it is a return of
our original problems or another episode of depression. This in turn often
leads to long-term treatment with antidepressants.
Not advising patients when they are
first prescribed antidepressants of the potential difficulty they might have
withdrawing has perhaps led to the unnecessary medication of millions. It is
one of the most important discussions needed to enable real informed consent.
Blaming adverse effects or withdrawal effects on relapse or discontinuation syndrome
has meant millions of us have been persuaded to remain on antidepressants
longer than needed. It has also delayed crucial research being undertaken to
develop withdrawal guidelines and protocols. As Christopher Lane says, “The
number of people affected would, in any normal situation, drive a lot more
targeted research on the problem,” but this is not a normal situation. Once
again, it is all about the power of the pharmaceutical marketing language used
in their strategy to keep us medicated.
What research has been done to look at
antidepressant withdrawal effects and why has this area been neglected?
Although the first antidepressant, Prozac,
was introduced in 1988, the first systematic review on withdrawal was not
published until 2015. There were almost 200 meta-analyses on the efficacy of
new-generation antidepressants published between 2007 and 2014. Most of these
efficacy studies were pharmaceutical funded at a time when they were trying to
prove to each other, “our antidepressant is better than your antidepressant.”
When it first became apparent some
of us were having difficulty withdrawing from antidepressants, the
pharmaceutical industry adopted the term “discontinuation syndrome,” rather
than withdrawal effects to try to cover up the severity of problems we were
encountering.
Massabki and Abi-Jaoude write, “From
a critical review of the term discontinuation syndrome in the literature, it is
clear that the use of the term in place of withdrawal is not justified... the
use of the term in the literature grew markedly after pharmaceutical
company-sponsored conferences in 1997 and 2006. The term discontinuation
syndrome, compared with its counterpart withdrawal, does not entail similar
negative connotation and, as a result, may serve to reduce patients’ fears of
dependence. Several authors have expressed concerns that if patients worry
about developing dependence or addiction to antidepressants, they may decide to
not pursue such treatments. Such arguments are inconsistent with principles of
autonomy and informed consent. An aforementioned survey of 1829 individuals
taking antidepressants found that only 1% recalled having been informed about
withdrawal effects when they were prescribed the drug. The use of the term
withdrawal better enables patients to make appropriately informed decisions.”162
In the 2018 review, “A systematic
review into the incidence, severity and duration of antidepressant withdrawal
effects: Are guidelines evidence-based?” Dr. James Davies and Professor John
Read questioned the UK’s current National Institute for Health and Care
Excellence (NICE) and the American Psychiatric Association’s (APA) depression
guidelines, which said withdrawal reactions from antidepressants are “self-limiting”
(i.e. typically resolving between 1 and 2 weeks). Davies and Read conducted a
literature review to better understand the incidence, severity and duration of
antidepressant withdrawal reactions.
They identified 23 relevant studies,
with different methodologies and sample sizes and concluded “More than half
(56%) of people who attempt to come off antidepressants experience withdrawal
effects. Nearly half (46%) of people experiencing withdrawal effects describe
them as severe. It is not uncommon for the withdrawal effects to last for
several weeks or months. Current UK and USA Guidelines underestimate the
severity and duration of antidepressant withdrawal, with significant clinical
implications.
We recommend that UK and USA
guidelines on antidepressant withdrawal be urgently updated as they are clearly
at variance with the evidence on the incidence, severity, and duration of
antidepressant withdrawal, and are probably leading to the widespread
misdiagnosing of withdrawal, the consequent lengthening of antidepressant use,
much unnecessary antidepressant prescribing and higher rates of antidepressant
prescriptions overall. We also recommend that prescribers fully inform patients
about the possibility of withdrawal effects.”163
What we actually do know about
antidepressant withdrawal effects comes mostly from the experiences of patients
and anecdotal evidence. It is not through scientific research but through
listening to the experiences of others, mostly online. Thankfully, scientific
literature is now starting to agree with patient experiences and in
“Withdrawal-the tide is finally turning,”164,165 Michael P. Hengartner, John
Read and James Davies write about the progress made when making the case that
withdrawal from antidepressant drugs is often longer-lasting and severe.
“Withdrawal reactions when coming
off antidepressants have long been neglected or minimized. It took almost two
decades after the selective serotonin reuptake inhibitors (SSRIs) entered the
market for the first systematic review to be published. More reviews have
followed, demonstrating that the dominant and long-held view that withdrawal is
mostly mild, affects only a small minority and resolves spontaneously within
1-2 weeks, was at odds with the sparse but growing evidence base. What the
scientific literature reveals is in close agreement with the thousands of
service user testimonies available online in large forums. It suggests that
withdrawal reactions are quite common, that they may last from a few weeks to
several months or even longer, and that they are often severe. These findings
are now increasingly acknowledged by official professional bodies and
societies.”166,167
Once again, the point is made that
if we knew about the seriousness of withdrawal effects, many of us would choose
not to take antidepressants or would limit the time we take them. They
highlight the lack of support and the fact that we are often told that
withdrawal symptoms are due to the return of our illness. Thanks to Davies and
Read and the many campaigners in the UK, the National Institute for Health and
Care Excellence (NICE), amended its 2009 guidelines on depression to recognize
the severity and length of antidepressant withdrawal symptoms. The new
guidelines state that withdrawal symptoms may be severe and protracted in some
patients.
For some, fear of withdrawal
symptoms is often the reason so many patients take antidepressants for long
periods. Some doctors still choose to deny our symptoms are those of withdrawal
and just as with adverse effects, it is not uncommon for patients to be ignored
when complaining about withdrawal symptoms. There is still so much
misinformation online about withdrawal symptoms, why we have them, how long
they last and how to prevent them.
Recognizing withdrawal effects is
one issue but how to prevent them happening is surely the one we now need to
address. We urgently need to have official guidelines on how to help prevent
harm and ensure we can manage antidepressant withdrawal safely. It is at this
point we need to be reminded just how “wicked” a problem this is.168
What are the symptoms we might experience
when withdrawing from antidepressants?
The Inner Compass Initiative’s “The
Withdrawal Project” sums up withdrawal effects perfectly when it describes them
as “unique”. They can be varied and unpredictable and different for every one
of us.
“Another by-product of psychiatric
drug-induced dependence is the emergence of mental, emotional, physical, cognitive,
and sleep-related problems upon the reduction or cessation of a medication.
Psychiatric drug withdrawal is a very unique, individual experience that can
involve few or many of a vast spectrum of symptoms. It is becoming clear based
on anecdotal reports from the withdrawal community that two people can take the
same amount of the same drug or take a drug for the same length of time and
have completely different withdrawal experiences.”169
Some of the most common withdrawal
effects reported; headaches, electric shock sensations (e.g. “brain zaps”),
paresthesia or burning, prickly or skin-crawling sensations, flu-like symptoms,
nausea, tiredness, insomnia and sleep issues, dizziness and vertigo, vivid
dreams, nightmares, amnesia, irritability, nervousness and anxiety, panic
attacks, depersonalization, agitation and depression, mania, aggressive or
impulsive behavior, suicidal ideation, akathisia, psychosis, cognitive
impairment, mood problems, excessive sweating, sexual dysfunction,
gastrointestinal issues, movement disorders, speech changes, sensory problems
like tinnitus, drop in blood pressure, muscle pain or weakness.
We know withdrawal effects are more
likely with higher doses of antidepressants or/and the longer our exposure to
the medication. Antidepressants with shorter half-lives are likely to produce
more effects and within a shorter period of time (2 days as opposed 2-6 weeks
for antidepressants with a longer half-life). The half-life of an antidepressant
is the time it takes for our body to break down and remove half of a medication
from our system.
An antidepressant with a short
half-life leaves our body faster than one with a longer half-life.
Antidepressant |
Approximate Half-Life (Hours) |
Citalopram |
36 |
Desvenlafaxine |
11 |
Duloxetine |
30 |
Escitalopram |
8-17 |
Fluoxetine |
96-144 |
Fluvoxamine |
24 |
Levomilnacipran |
12 |
Milnacipran |
8 |
Paroxetine |
17-22 |
Sertraline |
22-36 |
Venlafaxine |
4-7 |
What does the existing research tell us
about the best way to withdraw from antidepressants?
“About 37 million in the US are prescribed
antidepressants in any given month (about 13% of the adult population) and half
of those have been taking them for at least 5 years. We now know for certain
that millions of people in the US and beyond struggle when they try to come off
these drugs. Underestimating the problem is not going to help patients get the
accurate information, and the withdrawal support services, they need and
deserve.”170
Very little research has been done
regarding how to withdraw from antidepressants. This is because the medical
profession has denied the severity of withdrawal effects and how difficult it
can be to stop taking them. They have preferred to remain uneducated and
accepting of the fact that the easiest (and most profitable) option is to keep
prescribing and keep us medicated.
In their most recent Guideline on
Major Depressive Disorder, in 2010, the American Psychiatric Association write,
“When pharmacotherapy is being discontinued, it is best to taper the medication
over the course of at least several weeks. Such tapering allows for the
detection of recurring symptoms at a time when patients are still partially
treated and therefore more easily returned to full therapeutic treatment if
needed. In addition, such tapering can help minimize the incidence of
antidepressant medication discontinuation syndromes, particularly with
paroxetine and venlafaxine.”
The UK Royal College of Psychiatry
leaflet, “Stopping Antidepressants”, which was published in 2020, tells us,
“This is different for everyone. If you have been taking an antidepressant for
only a few weeks you may be able to reduce, and stop, over a month or so. Even
if you have only mild (or no) withdrawal symptoms, it is best to do this over
at least four weeks. If you have been taking antidepressants for many months or
years, it’s best to taper more slowly (again, at a rate you find comfortable).
This will usually be over a period of months or longer. It’s also best to
reduce the dose slowly if you have had withdrawal symptoms in the past.”
But on what research are these inadequate
guidelines from two incredibly powerful and respected organizations based on?
Where are the worldwide studies to help the millions trying to withdraw from
antidepressants?
In their 2019 paper, “Tapering of SSRI
treatment to mitigate withdrawal symptoms.”171 Dr. Mark Horowitz, PhD, and
Professor David Taylor recommend hyperbolic tapering. “SSRIs work by inhibiting
the serotonin transporter, and the relationship between the dose and the level
of binding to the transporter is hyperbolic. When the patient is taking low
doses, the level of binding increases very rapidly, and then levels off at
higher doses. A patient using only registered doses takes steps down which are
too large. When the patient begins tapering from a high dose, these steps have
a limited impact on transporter binding. But, at low doses, this impact is significant.
So, even a small dose decrease can
have a big effect. This hyperbolic relationship explains why withdrawal
symptoms are often most problematic towards the end of a taper. Dose steps down
that are lower than registered doses are required to achieve smaller steps to
avoid withdrawal symptoms—this is known as hyperbolic tapering.”172
“We suggest that, in the absence of
more robust evidence to guide tapering (especially where guidelines advise to
taper gradually without specific instructions), the tapering regimen described
here should be considered for adoption into clinical practice. There are few
disadvantages of recommending slower tapers. It should at least be recognized
that tapering periods of 2-4 weeks are likely to be inadequate for reducing
withdrawal symptoms for many patients, with longer periods of tapering, and
regimens that include lower doses of medication, more likely to be effective.
Further empirical study of tapering regimens, including the one proposed here,
is urgently required, with a consequent update of formal guidelines.”173
In April 2021, in the Cochrane
Report “Approaches for discontinuation versus continuation of long-term
antidepressant use for depressive and anxiety disorders in adults”, Dr Mark
Horowitz and Belgian-based researcher and GP, Dr Ellen Van Leeuwen, looked at
the findings from 33 Random Controlled Trials (RCTs) that included 4,995
participants who were prescribed antidepressants for 24 weeks or longer. In 13
studies, the antidepressant was stopped abruptly; in 18, it was stopped over a
few weeks (known as ‘tapering’); in four, psychological therapy support was
also offered; and in one study, stopping was prompted by a letter to GPs with
guidance on tapering. Most tapering schemes lasted four weeks or less and none
of the studies used very slow tapering schemes beyond a few weeks - in contrast
to new guidelines from the UK Royal College of Psychiatrists that recommend
tapering over months or years to safely stop.
“We compared different approaches
and looked at benefits (such as successful stopping rates) and harms (such as
return of the depressive or anxiety episodes, side effects and withdrawal
symptoms),” says Dr Van Leeuwen. “Our review outlines detailed findings across
all these areas, but in a nutshell there was only very low certainty evidence
on the pros and cons of each of the different approaches to stopping—making it
difficult to reach any firm conclusions at this time. The key issue is that
studies do not distinguish between symptoms of a return (or relapse) of
depression and symptoms of withdrawal after stopping, and that’s really
problematic.”
In “Strategies to reduce use of
antidepressants”,174
Professor Tony Kendrick suggests, “Prescribers should actively review long-term
antidepressant use and suggest coming off them slowly to patients who are well.
The relationship between SSRI dose and serotonin transporter receptor occupancy
suggests that hyperbolic tapering regimes may be helpful for patients with
troubling withdrawal symptoms who cannot stop treatment within 4-8 weeks, and
tapering strips can allow carefully titrated slower dose reduction over some
months. Internet and telephone support to patients wanting to reduce their
antidepressants is being trialed in the REDUCE programme.” The REDUCE Programme175
is a UK £2.4 million funded 6-year project (2016-2022); “We aim to identify
feasible, safe, reliable and cost-effective (value for money) ways of helping
patients withdraw from long-term antidepressants, where this is appropriate.”176
In Australia, a trial called STOPS177
(STructured Online intervention to Promote and Support antidepressant
de-prescribing in primary care), is aiming to provide on-line guidance (called
WiserAd) and practice nurse support to patients. “The incidence of
antidepressant withdrawal symptoms in representative samples of patients
tapering off antidepressants and risk factors which predict more withdrawal
symptoms in prospective studies to avoid recall bias” are also being studied by
the OPERA project,178
a Netherlands Study of Optimal, PERsonal Antidepressant use.
Much more research and larger trials
on how to safely withdraw from antidepressants are urgently needed to compare
different tapering methods. We urgently need the pharmaceutical industry to
produce drugs in lower doses and as liquid formulation. We need official and
evidence-based guidelines to educate professionals and the public on how to
safely manage their antidepressants, but one thing is very clear, there will
never be one single solution to this growing problem. Because of the many
variables, it seems there might only ever be guidelines. We now recognize
withdrawal effects can sometimes be severe, but we are still presented with
solving the problem of how to stop taking antidepressants and preventing
possible harm.
Is it time to ask who the real
experts are? We are realizing the medical profession has, for the foreseeable
future, no good answers for people struggling to stop taking antidepressants
and no means to determine who is at highest risk of being unable to stop. It is
time to face the fact that if anything is going to change, it will be because
of the valuable and substantial existing and growing patient experiences and
their knowledge. As governments and the medical profession continue to
underestimate and ignore the problem, we find ourselves in a situation where,
for the current time at least, it is down to the power of patient experience to
change and improve the situation we find ourselves in.
Tapering strips might enable us to have
more control of our antidepressant reductions.
One of the difficulties when trying to
withdraw or reduce antidepressants is they only come in a limited number of
doses. Making very small reductions can be difficult and we often need to
resort to cutting pills, counting beads or taking a liquid if available.
Tapering strips are 28-day rolls of daily pouches of antidepressants. They can
be used to reduce our antidepressant doses at a rate decided by us. They enable
us to make much smaller dose reductions so we can work with our prescriber to
create a personalized tapering schedule at a much slower rate. The key is to
avoid large cuts in dose to minimize withdrawal effects. This enables a
hyperbolic taper with smaller and smaller doses, as recommended by Mark
Horowitz and David Taylor.179
“Tapering strips allow patients to
regulate the tempo of their dose reduction over time and enable them to taper
more gradually, conveniently and safely than is possible using currently
available standard medication, thereby preventing withdrawal symptoms.”180
The evidence says they work. In a
recent study “The previously reported 71% short-term success rate of tapering
strips in the most severely affected group, was matched by a 68% rate after 1-5
years. The evidence-based approach of personal tapering to counter withdrawal,
as used for drugs causing withdrawal, for example, benzodiazepines, may
represent a simple solution for an important antidepressant-related public
health problem, without extra costs.”181
The Tapering Project was established
in 2010 to develop tapered doses of medication and tapering strips are
available in the Netherlands.182
They can be sent worldwide (legislation allowing). They are available for a
wide range of drugs including antipsychotics and sedatives. There is an obvious
need for the pharmaceutical industry to make antidepressants available in lower
doses or, in an ideal world, produce tapering strips themselves.
A petition in the UK is asking the
UK medical authorities to trial and implement tapering strips which provide the
most commonly prescribed medications in decreasing doses over a period of time.
It is hoped this will help millions of users of psychoactive prescription
drugs. This petition can be found at https//www.change.org/p/provide-tapering-
strips-to-help-people-withdraw-from-antidepressant-and-antipsychotic-drugs.
PART 3
Safe Antidepressant
Management and
Withdrawal
16
ADOPTING A HARM
REDUCTION APPROACH
There are many reasons it is important we
never stop taking or start withdrawing from antidepressants or other
psychotropic medication without the support of a knowledgeable medical
professional or support service. Antidepressant treatment should be supported
by frequent reviews. We need to be aware, from the very first pill we take, of
any physical or psychological changes we experience and report them immediately
to our prescriber. Evidence suggests the risk of suicide, self-harm or other
severe adverse events is significantly higher when commencing, stopping or
changing doses or switching drugs including generics.
When should we consider “coming off” or
managing our antidepressants?
The simple answer
is if we decide to take antidepressants, we should stay on them for the
shortest time possible. If we were told when we were given our
very first prescription that stopping taking antidepressants can be incredibly
difficult and even dangerous for some, it might have made us think twice about
our choices. Being told this rarely happens and for many of us, it is not until
we are faced with the challenge of reducing antidepressants, we realize how
little we know about the psychoactive drug we might have ingested for years or
sometimes decades. It is often at this time we realize the significant effects
antidepressants have had on our minds and bodies.
In an article published in the
British Journal of General Practice, (BJGP), researcher and campaigner Stevie
Lewis writes about her experience with antidepressant withdrawal. In “The four
research papers I wish my doctor had read before prescribing an
antidepressant,” she points to four significant studies that she wishes her
doctor had read before prescribing her antidepressants in 1996. She goes on to
summarize the findings of these important studies (found at
bjgp.org/content/71/708/316/tab-article-info).
Deciding to reduce antidepressants
is a personal choice. Whether or not it is right for us to stay on or try to
reduce antidepressants should ALWAYS be a decision we make with the support of
a knowledgeable medical professional or support service.
What are the main reasons people decide to
“stop” taking antidepressants?
There are many reasons we might decide we
want to stop taking antidepressants and they will be personal to us. They might
include:
·
Adverse effects such as lack of emotion,
feeling numb, feeling tired, weight gain, depersonalization, being angry or
irritable or any of the many other, sometimes serious adverse effects we can
experience
·
Sexual problems
·
Financial reasons
·
Pregnancy
·
Stigma
·
Feeling suicidal
·
We don’t think they are working, or we
don’t think we need them anymore
No one can tell us how our attempt to
reduce antidepressants will affect us, but there are important things we need
to know before start. It is about how we approach it!
Suddenly deciding to come off
antidepressants is like suddenly getting up one day, and out of the blue, with
no training, deciding to run a marathon. You can’t do it without being
prepared. Some of us, no matter how hard we train, will never run those 26
miles but might benefit substantially from being able to do a regular 5-mile
walk.
We need to start by being the most informed
we can be.
Just as we should when starting
antidepressants, we should make informed choices about how we manage our
reductions.
It is important to realize there are
no tried, tested and approved ways to withdraw from antidepressants. There is
so much information and guidance on the internet, but it can be difficult to
work out where to start. How do we know what is the good advice and which might
be harmful? We need to trust ourselves during this process and we might do well
to learn about adopting an informed “Harm Reduction” approach. As well as the
“Harm Reduction Guide” by the Icarus Project,184 The Inner Compass Initiative
have an excellent booklet to help us learn more about antidepressants and
management/withdrawal.185
“Harm Reduction is different: pragmatic,
not dogmatic. Harm reduction is an international movement in community health
education that recognizes there is no single solution for each person, no
universal standard of “success or failure”. Getting rid of the problem is not
necessarily the only way. Instead, harm reduction accepts where people are at
and educates them to make informed choices and calculated trade-offs that
reduce risk and increase wellness. People need information, options, resources
and support so they can move towards healthier living—at their own pace and on
their own terms.”183
17
LEARNING ABOUT OUR
ANTIDEPRESSANTS AND
LISTENING TO OUR BODY
W |
E NEED TO learn as
much as we can about the antidepressant we are taking. The Inner Compass
Withdrawal Project recommends:
·
“Get informed about the drugs you take
·
Determine whether the medications you’re
planning to reduce or come off are in a ‘taper-friendly’ form
·
Learn about risky interactions, reactions and
sensitivities that can happen during withdrawal
·
Review the taper rates, schedules, and
methods commonly used in the layperson withdrawal community
·
Walk through the various decisions, gear,
and skills needed for your chosen taper method
·
Get a sense of how laypeople typically
implement their taper methods”186
Reading guidelines and patient experiences
are important. Use this book’s “Resource Guide” to help find guidance and
reliable information.
We need to get as much support as we can.
We are advised to only take advice from a
knowledgeable clinician or specialist support service but there is very little
good professional support available for those of us who wish to reduce our
antidepressants. Free services should be available to everyone who needs them
but only a handful exist.
It is important we inform a
relative, friend or colleague we trust, of our plans to reduce our medication
and ask them if they will learn with us. Sometimes it is also about creating
our own support system.
What if my prescriber won’t support me?
Ask them to explain their reasons. They
might be ones we need to consider. Let them know we are / intend to be informed
and educated about the risks associated. Many people do reduce their medication
without their prescriber’s support, but it is always advisable to try to get
them on our side.
Explain what we have read and why we
think it is the best decision for us. It might be good to make them aware we
realize it might be a long process and we know it doesn’t have to be an all or
nothing result. We should emphasize our wish to improve our health by trying to
manage our medication. No one can make us take antidepressants and no one can
prevent us attempting to reduce them. We need to find a professional who is
willing to listen, work with us and let us choose our own rates of reductions.
Accept not all of us will be able to ‘come
off’ antidepressants. Think about achieving that 5k walk and we might, in time,
run that marathon.
The longer we have taken antidepressants,
the more difficult it might be to stop taking them. If we have taken them for a
long time, years rather than months, we need to go incredibly slowly. Time is
our best friend, and we need to think of this in terms of a project which might
take years rather than months. We also need to consider that coming off
antidepressants is not always the best option for us, and our unique situation
must always be considered. Not everyone will be able to come off their
antidepressants successfully.
Dr. Stuart Shipko writes, “advise
caution and warn of possible serious withdrawal symptoms for people with a
cumulative use of antidepressants for five years or more. With cumulative use
of ten years or more, I advise that there is a meaningful chance of disabling
and persistent symptoms and usually do not support even attempting to taper and
stop the drugs.”187
But not everyone will find “coming
off’ antidepressants problematic. The shorter the time we have taken
antidepressants and the lower the dose, the less problems we might have
reducing them. This is not a reason to take chances with coming off too quickly
and we should never quit suddenly or cold turkey unless there is a clinical reason
for doing so as advised by a clinician.
Everyone starts from a different place.
From the beginning we need to accept withdrawing from antidepressants cannot be
“prescriptive”.
It might have started with prescribing, but
antidepressant withdrawal cannot be prescriptive. There is no way anyone can
give us an exact personal method and timescale. It is about listening to and
learning from our own body. Our particular experience with antidepressants is
unique to us. We are the only one who knows our body and how it is feeling. We
cannot predict how our body will react to medication reductions, but we can
listen to our body and make decisions based on staying well and maintaining a
quality of life. Our body will tell us if we are getting it right. We need to stay
as physically and mentally balanced as we can and manage our antidepressant
reductions with as few adverse effects as possible. Staying in control with the
help of our professional and personal support system is vital.
It is important that we start in a
balanced place. It needs to be one as free from personal, emotional and social
stresses as possible. Attempting to reduce antidepressants is not the time to
address the “why me?” or “who do I blame?” questions which we might have about
our life on antidepressants. From the start it is important we try to remain
aware of and connected to life around us. We need to keep a record of our
medication reductions and any emotional and physical changes from the very
start but at the same time it is important the issue does not take over our
life. Being obsessed and having our lives dominated by the issue can be
counterproductive.
We need to listen to our body for
warnings signs we might be reducing too fast! It will tell us if our “slow” is
not slow enough. “It is my strong view that for the time being it is most
helpful to leave aside all sorts of theoretical considerations and agree that
the most helpful approach for helping patients is to listen to them and to
allow them to taper at a speed they agree with.”188
Again, we need to keep a record of
our medication reductions and any emotional and physical changes we experience.
Our physical and psychological responses to dose reductions best dictates our
schedule to reduce medication but it is not just about doses. It is also about
making reductions at the right time.
It is
important to remember that we do not know our level of dependence on
antidepressants before we start this process! Severe symptoms in
the early stages might indicate a higher level of dependence. This should be a
warning that we need to make very small reductions very slowly. Time and
patience are our best friends when it comes to reducing antidepressants. We
need to try to do it with as few “withdrawal symptoms” as possible, enabling us
to get on with our lives as best we can. Each time we make a reduction, our
brain and body are adjusting to yet more changes and we need to give them time
to adapt. Most people talk in terms of “months” for withdrawal, but anecdotal
evidence tells us “years” might be needed to reduce successfully and without
symptoms which impact our life. Quality of life, whilst trying to reduce, is
one of the most important considerations.
Again, our response to reductions
best indicates how slowly we need to reduce taking our antidepressants and
warns us if we are going too fast! When we begin, because we have no idea of
our level of dependence on antidepressants and it is impossible to know if our
slow will be slow enough.
“Many people—especially those who
taper slowly and follow careful tapering protocols in line with the messages of
the body-experience few or none of these symptoms; however, many do experience
at least some of them.”189
Reducing doses incredibly slowly
allows the brain and body to adapt and get used to the changes. There is no
word to describe what this “slowly” really means. Patience is our best friend
during this process. What is the point in wasting years tapering quickly, going
back on a higher dose, constantly suffering withdrawal symptoms, if a
“tortoise-like-taper” might allow us to maintain a reasonable quality of life?
Trying to reduce our antidepressants
might be one of the hardest things we ever do. Readjusting and resetting
involves important “rebalancing” acts, and this should never be regarded as
failure.
There is little point trying to
suffer and put up with “adverse effects”; with medical supervision, we can go
back to the last place/dose we felt well enough to live our lives without
adverse effects. If we are advised by our doctor to go back to a previous dose,
this should not be regarded as a set-back but rather good and sensible
medication management. We can try to make a smaller reduction next time or give
ourselves much longer to get used to the previous dose. Once again, it is about
listening to our body.
Beware of the “relapse” trap...we might
have just gone too quickly.
Withdrawal symptoms can sometimes resemble
symptoms associated with “mental illness”. It is common for doctors and
psychiatrists to call this relapse and prescribe us more drugs. As we have
previously learned, blaming withdrawal effects on relapse has meant millions of
patients have been persuaded to remain on antidepressants longer than needed.
Once again this is a time to take advice, reset, slow down and maybe go back to
a place we were balanced.
We have to learn to deal with normal
emotions as well as dealing with the impact the drug has had on our lives.
Managing and reducing antidepressants is a huge deal in anyone’s life but it is
important it doesn’t become all consuming. We need to try to still have a life
while we deal with it. It is also important not to blame every emotion we might
experience on the antidepressant reduction. We should still be aware of life
around us and its ups and downs. Actually, making life changes can be a useful
way to focus on “living” and taking our minds off the drugs.
Be prepared to make useful life changes.
It is about looking after ourselves the
best we can. Having a strong immune system is helpful. Drinking plenty of
water, eating as healthily as we can and trying to exercise are important parts
of the withdrawal process. More than this they can provide an outlet. We need
to try to keep life as normal as possible and try to stay in control. Finding a
therapist who understands the issue can also be a huge help.
Counselling and Talk Therapy
A therapist can be the human contact we
need whilst we are trying to withdraw from antidepressants. The problem is
finding one who understands the issues we are dealing with and also many of us
are not in a position to access or pay for private therapy. Finding a therapist
who understands can be a huge help. The “Guidance for Psychological Therapists”
is available online and was produced by the UK All-Party Parliamentary Group
for Prescribed Drug Dependence (APPG for PDD),190 professional bodies for
psychological therapists in the UK, key academics and other professionals. It
aims to “support therapists in deepening their knowledge and reflection on
working with clients prescribed psychiatric drugs such as antidepressants and
antipsychotics.”
Learning the Language of Antidepressant
Management and Withdrawal
The Resource Guide starting on page 246
includes websites and literature which can help us learn more about and where
to find the key information we need when considering managing or withdrawing
from our antidepressants. This is rarely a straightforward process, and being
as knowledgeable as we can be is a powerful asset. Also included in the guide
are links to published withdrawal protocols. It is important to remember we can
become our own expert and should use these as guidelines not individual
prescriptions. This is information and not individual advice.
18
WITHDRAWAL AND THE
EXISTING PROFESSIONAL ADVICE
What “official” advice exists about
withdrawing from antidepressants?
According to the New York Times analysis of
federal data, “More than 15 million Americans have taken the medications for at
least five years, a rate that has almost more than tripled since 2000.”191
It says, “Thousands, perhaps millions, of people who try to quit antidepressant
drugs experience stinging withdrawal symptoms that last for months to years:
insomnia, surges of anxiety, even so-called brain zaps, sensations of electric
shock in the brain. But doctors have dismissed or downplayed such symptoms,
often attributing them to the recurrence of underlying mood problems.”
So where do the millions in the US
and around the world go to get help? Despite perhaps millions struggling with
withdrawal, the American Psychiatric Association appear to have very little to
say on the issue. Their “Practice Guideline for the Treatment of Patients with
Major Depressive Disorder” has not been updated since 2010. The guideline has
158 pages and on page 59, hidden in the small print, is the following brief
advice on antidepressant discontinuation. “When pharmacotherapy is being
discontinued, it is best to taper the medication over the course of at least
several weeks. Such tapering allows for the detection of recurring symptoms at
a time when patients are still partially treated and therefore more easily
returned to full therapeutic treatment if needed. In addition, such tapering
can help minimize the incidence of antidepressant medication discontinuation
syndromes, particularly with paroxetine and venlafaxine.”192
The APA advice is grossly
inadequate, outdated and misleading. Millions of people, including our
prescribers, need up to date, best practice advice and guidelines. Is this the
best the American Psychiatric Association has to offer at a time when the
medical profession is becoming increasingly aware this is a public health issue
it urgently needs to address? Truth is, finding help withdrawing from
antidepressants can prove difficult and there is little official support available.
The UK’s National Institute for
Health and Care Excellence’s (NICE) guideline on the recognition and management
of depression in adults, published in 2009, recommended that patients are
tapered off their drugs over a period of up to four weeks and symptoms were
“usually mild and self-limiting over about one week.” Thankfully in September
2019, NICE amended its guidance to recognize that withdrawal symptoms can
persist for months or more and be “more severe for some patients”. The UK Royal
College of Psychiatry (RCPsych) said it wanted to see a greater focus on how to
help patients who are withdrawing from antidepressants and it wanted NICE to
develop “clear evidence-based and pharmacologically-informed recommendations to
help guide gradual withdrawal from antidepressant use.” It also said it wants
to see routine monitoring of when and why patients are prescribed
antidepressants, and GPs being allowed the time needed to regularly review
medication with patients and offer them support and advice.
In 2020, the Royal College of
Psychiatrists published a leaflet on “Stopping Antidepressants”.193 This came after years of
pressure from academics and campaigners who have challenged RCPscyh’s previous
position on antidepressant withdrawal.
The RCPysch leaflet (see the
Resource Guide on page 246) comes with a disclaimer which makes it clear the
“Stopping Antidepressants” leaflet provides information and not advice. RCPsych
make no guarantees their content is accurate, complete or up to date. It cannot
be relied on, and we need “relevant professional or specialist advice.”
Undoubtedly, it is time for the
developed world to address the issue of antidepressant withdrawal as a matter
of urgency. It should of course be the responsibility of those who created the
problem to solve it. But right now, it seems change will come from the patients
and those who advocate for change. By becoming informed, educated, and sharing
our knowledge, it is hoped that we will eventually reduce the role and impact
antidepressants have on our lives and society.
Where do we go to find the “relevant and
specialist” advice the UK Royal College of Psychiatrists suggests we take? Why
do we need to be careful where we look for help?
Throughout the “Stopping Antidepressants”
leaflet, we are directed to our doctor (prescriber), and pharmacist to put
together our “tapering plan”. Some prescribers might have the knowledge to
support us, but it is generally acknowledged, prescribers urgently need education,
resources and development of best practice guidelines to help their patients.
The British Medical Association (BMA) has said for a number of years, “This
represents a significant public health issue, one that is central to doctors’
clinical role, and one that the medical profession has a clear responsibility
to help address.”194
This is true throughout the developed world.
Wherever we live, it can be
difficult to get reliable and knowledgeable support from the medical profession
to help us manage and withdraw from antidepressants. This has left people
turning to the internet for support and guidance and many informative and
valuable websites have been developed. In this book’s Resource Guide are the
best sources of information if we want to learn the safest way to withdraw from
antidepressants. They provide guidelines but we should always remember this is
not personal advice.
The internet can be our best friend
and our worst enemy. It requires an open-minded approach and the realization,
when it comes to antidepressants, we can’t trust everything we read online.
“A study of websites offering advice
about antidepressants has found widespread misinformation, and widespread
backing by drug companies. As people are flocking in record numbers to get
their medical advice online, thanks to the coronavirus, it is time to expose
the risks.”195
Prof Peter Gøtzsche and Dr. Mayanne
Demasi analyzed 39 websites published by government bodies, consumer
organizations and patient advocacy groups, focusing on SSRI antidepressants, to
find out how online information about the benefits and harms of medicines were
being conveyed to the public.196
All 39 websites mentioned the benefits of antidepressants. Gøtzsche and Demasi
concluded, “None of the websites met our predefined criteria. The information
was generally inaccurate and unhelpful and has potential to lead to
inappropriate use and overuse of antidepressants and reduce the likelihood that
people will seek better options for depression like psychotherapy.” Twenty-nine
(74%) websites attributed depression to a “chemical imbalance” or claimed they
could fix an imbalance.
Sexual dysfunction was mentioned as
a harmful effect on 23 (59%) websites while five (13%) mentioned emotional
numbing. Twenty-five (64%) stated that antidepressants may cause increased
suicidal ideation, but 23 (92%) of them contained incorrect information, and
only two (5%) websites noted that the suicide risk is increased in people of
all ages. Twenty-eight websites (72%) warned patients about withdrawal effects
but only one stated that antidepressants can be addictive.”
Many websites and forums about
antidepressants have been developed and are mostly found on social media. Some
of them can be excellent reliable ways to learn about all aspects of taking and
withdrawing from antidepressants. Some of the sites have tens of thousands of
followers. There are many debates and questions about whether Social Networking
sites are good or bad for our mental health in general. People often say these
sites saved their lives at a time when they could find no answers from the
medical profession and yet others have warned of bullying and misinformation.
One thing seems certain, at a time when many of us might feel isolated and
vulnerable, social media sites can give us social support and connectedness.
They can, through our self-education, give us a sense of empowerment over our
situation. At the same time, it is important we remember that the evidence we
find on sites is mostly anecdotal and although it can be valuable, information
should be used as guidelines and not personal advice.
Online we can also find private
centers, like American Addictions Centers, which talk of “Detox and Withdrawal
from Antidepressants” and urge us “don’t wait call us now”.197 There are “Rehab Residences”
in the US where we can pay to get help. There are plenty of private clinics
ready and waiting to relieve us of tens of thousands of dollars to “get off”
antidepressants in what are often described as relaxing, luxurious surroundings
where we will be able to “get off” antidepressants in a comfortable setting!
They often promote outrageous claims such as “investigative work can begin that
can isolate the factors that need to be brought in balance.” Residential
clinics cannot solve our antidepressant problem in a matter of weeks, and we
need to be wary of their limitations and often overly optimistic promises which
can come at an incredibly high financial cost. These clinics are generally
alcohol and illicit drug rehabilitation services and mostly unsuitable for
those who need help with antidepressants and other psychiatric medications.
“If I thought that it was possible,
I would have opened a string of clinics all over the country to help get people
off of antidepressants. Unfortunately, the problems that sometimes occur when
people try to stop an SSRI antidepressant are much more severe and long-lasting
than the medical profession acknowledges, and there is no antidote to these
problems,” says Stuart Shipko.198
PART 4
Special Concerns
19
SAME BUT NOT THE
SAME:
UNDERSTANDING GENERICS
Could “same but not the same” generic
antidepressants be adding to the problems of antidepressant harm and
dependence? In an age of consumer choice, is, “You get what you are given”
acceptable?
Antidepressants have brand names and a
generic name (the medical name of the drug). Generic drugs, using the medical
name, can only be manufactured after the brand name drug’s patent has expired.
This can be up to 20 years after the patent holder’s drug is first filed with
the FDA. When patents or other periods of exclusivity expire, other
manufacturers can submit an Abbreviated New Drug Application (ANDA) to the FDA
for approval to market a generic version of the brand name drug. As an example,
manufacturers were able to apply to make a generic version of sertraline in
June 2006, when the patent for the brand name Zoloft expired.
We are told all manufacturers’
versions of sertraline are the same as Zoloft and each other. The generic
versions all contain the same mgs of sertraline, however, the differences are
where they are made, size, shape, color and most importantly price. Generics
can cost 20-90% less than the original price of their brand name equivalents.
Unlike the brand name drug, generic sertraline is approved only on the basis of
similarity and no clinical trials are necessary; generic drugs are not
“identical” but sufficiently “similar”. The similarities and differences of the
drugs are questionable and quality of manufacturing of generics is a genuine
concern.
“The proportion of branded vs.
generic drug prescriptions dispensed in the U.S. has decreased since 2005. In
2005, some 40 percent of prescriptions dispensed were brand name drugs and
around 50 percent of drugs dispensed were unbranded generic drugs. For
comparison, in 2019, only some 10 percent of prescriptions were brand-name
drugs while over 86 percent were unbranded generic drugs.”199
We increasingly hear complaints of
“they do not work as well” when switching from our usual brand drug to endless
boxes of unfamiliar cheaper generic drugs, but perhaps the issue is one more
complex and more dangerous than “they do not work as well.” The problem lies in
the number of different manufacturers making generic drugs and not specifically
the fact they are generic. Each time we receive a generic, we might be
receiving a different “make” of medication.
It is true that generic drugs must
demonstrate bioequivalence to the brand-name original, however, two pills with
the same amount of the same active therapeutic ingredient can cause different
effects on the human body if they dissolve at different times in the stomach,
if their active principles appear at different rates in the bloodstream, or if
their excipients (binders, fillers, dyes and shellac coatings which are often
of lower quality) influence the human body in different ways.
Generic medicines applications do
not make use of any data from the originator (Brand drug) registration file.
The data of originator products are never revealed to third parties so cannot
be used by generic medicines researchers. Instead, generic medicines’ producers
research and develop their own formulation of the product. Regulators do not
specifically regulate how quickly the medicine must reach maximum concentration
in the blood, which is an important aspect of time-released medication that can
impact its effectiveness. In short, the generic drug company only needs to test
to prove it performs “similarly” to the brand drug. This needs to be done on
only a few dozen healthy volunteers.
The interchangeability of some types
of medication has been straight-forward but for some it has been complicated
and contested. The British Generic Manufacturers Association (BGMA) is already
warning about psychotropic generics and say “proceed with caution” with certain
classes of drugs. They say making the switch with certain classes of drugs, and
with drugs that have a narrow therapeutic range can pose potential problems and
must be done with caution, if at all.
The FDA cites some psychotropic
drugs for which generic formulations may not be interchangeable—including
amitriptyline, perphenazine and venlafaxine—and others for which generic
formulations may not be bioequivalent at all doses. It says the type of salt
used to form a compound is also important and to avoid problems, physicians
should prescribe generics containing the same salt as their brand-name
counterpart!
In October 2009, the FDA declared
that a generic drug it had previously approved, a generic version of the
popular antidepressant Wellbutrin, was not in fact “bioequivalent” to the
name-brand version. Complaints by patients the drug budeprion XL 300 mg. didn’t
work as effectively and made them feel sick had been dismissed for years by the
FDA. However, an independent consumer laboratory tested the generic and found
that it dumped the active ingredient into the bloodstream at four times the
rate of the branded drug. The FDA took a highly unusual step, and it withdrew
approval for the generic. It required other generic companies to retest their
versions.
In 2008, a study “Did a switch to a
generic antidepressant cause relapse?” was undertaken.200 They concluded, “a switch to a
generic form of an antidepressant, antipsychotic, mood stabilizer, or
benzodiazepine, maintaining a concentration of only 80% of the original brand,
might result in a sudden change in efficacy yielding an increased risk of
withdrawal symptoms or even a relapse of a previously well-treated illness.
Alternatively, if a patient is switched to a generic drug that maintains a 120%
bioequivalence, there could be a sudden increase in adverse events. This could
lead to a decrease in compliance and potentially prompt a clinician to misread
the specific symptomatic presentation as a worsening of the symptoms.
Considering such risks, it is disconcerting to note that patients and their
physicians may not always realize that a switch has been made from a brand-name
drug to a generic.”
Anecdotal evidence tells us that
changing generics made by different manufacturers can cause adverse effects. We
know antidepressants “create” a chemical imbalance rather than “cure” one, but
the question is, could the changes of generic drugs/different “makes” create
new imbalances? Could some reports of nightmares, vomiting, anxiety, agitation,
panic attacks, insomnia, irritability, hostility, impulsivity, akathisia, and
mania in any way be linked to the quality and safety of generics? For some of
us it seems certain generics can make us feel as if we have suddenly commenced
an involuntary tapering of our medication. This is dangerous, as we know these
drugs should not be stopped or reduced without the supervision of a medical
professional. Failure to recognize switching between different makes of
generics might cause symptoms similar to withdrawal is alarming.
Are generic antidepressants putting
those of us dependent on medication at more risk of adverse effects? Are those
of us attempting to withdraw from antidepressants particularly at risk? As an
antidepressant’s half-life is a crucial factor in managing withdrawal, do we
need to be vigilant about prescribing different generics during tapering?
If generic antidepressants are “the
same but not the same” as brand name antidepressants, it is time we understood
the consequences of the strengths and limitations of the generic concept. We
might choose a breakfast cereal with less fruit and plain packaging to save
money, but it’s not the same as having cheaper generic drugs chosen for us
which might cause intolerance and psychological and physical adverse effects.
More research and patient and prescriber awareness will enable us to determine
under what circumstances is it safe to prescribe generics, substitute a brand
name drug for a generic or switch manufacturers of generics. It is just one
more issue to be added to the growing list of complexities associated with
antidepressants, particularly withdrawal.
We should take a note of generic
manufacturers’ drugs we cannot tolerate and notify our prescriber. If we
receive a generic/make which causes adverse effects we need to notify our
prescriber or pharmacist immediately.
20
PRESCRIBING
ANTIDEPRESSANTS TO
CHILDREN AND YOUNG PEOPLE
Why are we medicating children with mind
altering drugs? Is it time to question the morality of prescribing psychoactive
antidepressants to children?
According to Dainius Pūras, “The tendency
to medicalize children’s distress can lead to an approach whereby multiple
medications are prescribed for various symptoms, where some symptoms are
iatrogenic effects of the medications, despite the lack of evidence for poly-pharmacy
in children. Children have a right to thrive, to develop in a holistic way to
their full potential and enjoy good physical and mental health in a sustainable
world. It is crucial that investments are made to provide the nutritional,
educational and societal resources for healthy development, and that the
effects of adverse childhood experiences are addressed. It is important to
train mental health professionals and educate broader society to understand
that psychotropic medications are not effective first-choice treatment options
in child and adolescent mental health care and that excessive use of
psychotropic medications is not compliant with the right to health. A broad
variety of other interventions, such as watchful waiting and other psychosocial
interventions, must be available, accessible, acceptable and of sufficient
quality.”201
We know that there is rarely any
biological justification for prescribing antidepressants to anyone of any age.
We know these drugs create a chemical imbalance rather than cure one. We know
the effects of these drugs can be severe and long lasting and can increase
suicidality. We know the mental health diagnoses given to children are labels
created by psychiatry. So why does the medicalizing of child behavior and
emotions continue to be booming business for the pharmaceutical industry, with
millions of children and young adults being prescribed antidepressants in the
US and developed nations?
The pharmaceutical industry views
young people as an antidepressant mass market. Parents and care providers who
make decisions on their behalf have generally already bought into the
pharmaceutical sales pitch of our sadness, anxiety or loneliness being medical
issues.
Cultural behavior puts parents in a
“damned if you do and damned if you don’t” dilemma, with our children’s health
and wellbeing at stake.
In 2003, the UK Medicine and
Healthcare Regulatory Agency (MHRA) decided it would only recommend fluoxetine
for patients under 18 because of unfavorable risk benefit profiles for all
other SSRI antidepressants.202
Following this, in 2004, the FDA announced, “Today the Food and Drug
Administration (FDA) directed manufacturers of all antidepressant drugs to
revise the labeling for their products to include a boxed warning and expanded
warning statements that alert health care providers to an increased risk of
suicidality (suicidal thinking and behavior) in children and adolescents being
treated with these agents, and to include additional information about the
results of pediatric studies.”203
A Boxed Warning or Black Box warning
is the FDA Warning on a drug Patient Information Leaflet indicating the drug
has a serious risk of adverse effect which can be life-threatening. But even
with their Black Box Warning, the FDA continue to say, “Don’t leave childhood
depression untreated.” They view depression as an illness with associated
behaviors. They have a somewhat confusing message focusing on their belief they
are treating an “illness”, even though we know there are no tests of any kind
to prove depression is biological.
“Some parents might think that
medication is the solution for depression-related problem behavior. In fact,
that’s not the case. The Food and Drug Administration hasn’t approved any drugs
solely for the treatment of “behavior problems.” When the FDA approves a drug
for depression—whether for adults or children—it’s to treat the illness, not
the behavior associated with it. There are multiple parts to mental illness,
and the symptoms are usually what drug companies study and what parents worry
about. But it’s rare for us at FDA to target just one part of the illness,”
says Mitchell Mathis, M.D., a psychiatrist who is the Director of FDA’s
Division of Psychiatry Products.204
The following is the type of general
information we might see online regarding children and antidepressant
prescribing, telling us antidepressants don’t even need to be FDA approved for
our children. “There are two antidepressants that the FDA has approved for use
in children or teens to treat depression: Prozac (fluoxetine) for kids 8 and
older and Lexapro (escitalopram) for kids 12 and older. Additionally, Zoloft
(sertraline), Luvox (fluvoxamine), and Anafranil (clomipramine) have been
approved along with Prozac to treat kids with obsessive-compulsive disorder
(OCD). Just because a medication is not FDA-approved doesn’t mean that your
doctor won’t prescribe it, particularly if you have an older child. Physicians
often prescribe other antidepressants for children and teens that are not
FDA-approved because they have been proven to be effective and fairly safe. Be
sure to read the medication guide that comes with your child’s antidepressant
to find out more information, such as risks, side effects, and cautions.”205
Not only are we misinformed about
the potential dangers of prescribing antidepressants to our children, but we
are encouraged to look out for and have our children screened for signs of
mental illness, all pointing to whether or not a child might need a “medical
professional”. These are promoted as simple tests or “General Mental Health
Screening Tools”, but they might see our children on the life-changing road to
becoming lifelong psychiatric patients.
“Screening tools such as these can
help you begin to make sense of what your child is experiencing. Remember,
these assessments are not an official diagnosis but rather a guide for helping
you discern whether or not your child may benefit from a formal evaluation or
consultation with a medical professional. If you or your child complete any of
these assessments, bring them with you to your appointment with a medical or
mental health professional as they will find the information very helpful.
These screening tools can be an important step in your family getting the
support it needs and the professional treatment your child needs.”206
Despite the often laid-back attitude
towards children and antidepressants, “fairly safe” being commonly used, data
concerning the safety and efficacy of antidepressant use for children is far
from reassuring. There have been disturbing reports of SSRI trials and young
people, alleging drug companies hid unfavorable data, exaggerated the benefits
and hid the adverse effects, in particular the risk of suicidality.
In the short-term clinical trials of
SSRIs, 4% of the medicated youth became suicidal, which was double the rate for
those on placebo. This led the FDA to put a black box warning on
antidepressants that they increased the risk of a suicidal event. In a large
NIMH study, known as the TADs study, 22% of adolescents treated with an SSRI
had a suicide event, compared with 6.7% of those not taking the drug. Seventeen
of the 18 youths who attempted suicide during the study were taking an antidepressant.207
Research in Australia has revealed
an alarming link between rising antidepressant use and suicide rates among
young Australians; “the research examined Australian antidepressant prescribing
and suicide rates since controversial warnings by the US Food and Drug
Administration (FDA), in 2004 and 2007, that the use of antidepressants by
people under 25 years of age with depression was associated with approximately
double the risk of suicidal thoughts and behaviors.”208
There is particular concern over the
increase in prescribing to children during Covid-19. “One option is watchful
waiting, where parents and doctors closely monitor the young person and avoid
exposing them to the extra risk of suicidality identified by the FDA and TGA.
Throwing petrol on an already out of control fire is rarely a good idea.
Nonetheless, between July 2017 and June 2018, over 100,000 (1.8%) Australians
under 18 were prescribed an antidepressant. Some received these drugs for
anxiety, but many were prescribed them off-label for depression.”209
AntiDepAware is a website posting
articles and links to reports of inquests of more than 5500 self-inflicted
deaths related to the use of antidepressants. These are the tip of the iceberg
of actual cases worldwide. The site says many of the people who died by suicide
had not been depressed but had been prescribed antidepressants for conditions
such as anxiety, insomnia, PTSD, work-based stress or grief. It is important we
note the very large number of children and young people who are featured on
this site and their deaths linked to the antidepressants they had been prescribed.
There is a very real chance that
children prescribed antidepressants will possibly experience mood instability
sufficient to attract a label of bipolar disorder. A 2004 study at Yale
University, found the risk was particularly pronounced for children and
adolescents.
The use of an antidepressant
increased the conversion risk seven-fold for children 5 to 9 years old,
four-fold for those 10 to 14 years old, and slightly more than two-fold for
those 15 to 19 years old.210
The apparent rise in prevalence of “bipolar” in young adults in the US is very
concerning.
Some things just don’t make sense.
In an age where we obsess over food additives, protecting our children on-line,
keeping them safe from bullies and plastering them from head to toe in
sunscreen, why do we pay so little attention to the growing trend of
prescribing mind-altering antidepressants to children and young people? Why are
we allowing children to believe they are mentally ill and their problems can be
solved by popping psychoactive pills?
As parents we need education. None
of us wish to harm our children, but we are brainwashed by societal beliefs and
the medical profession in whom we put our trust. Instead of seeing our children
as needing medication, we need to help our children deal with suffering as part
of life, part of growing up. Whilst psychiatry says ordinary distress and
sadness is mental illness, we must teach children that however painful their
distress may be, it is, more often than not their normal reactions to the
difficulties of everyday life. Nothing is more cruel than allowing children to
believe they are mentally ill and their problems can be solved by
antidepressants.
Children are very rarely genuinely
mentally ill. More often they are subjected to social causes of anxiety or
sadness. General feelings of helplessness because of poverty, family and peer
relationships, loneliness, pressure from school and social media are the norm
in today’s society and yet we continuing to treat children as if they have
psychiatric disorders.
Prescribing antidepressants to
children is incompatible with “Building Resilient Kids”, a mantra heard
throughout education and social care. Telling children they can be resilient
when faced with poverty, broken and dysfunctional families and overwhelming
societal and educational pressures is one tool used by governments and the
powers that be. Antidepressants are just one more. Things go wrong when
children don’t live up to the expectations of today’s society. It seems it is
sometimes simply easier for some parents to buy into the false dangerous
narrative that, just like adults, children have a chemical imbalance causing
depression. Shouldn’t we be questioning why it all points to the child or their
brain being at fault and it is the child, not society which needs to be cured?
The United Nations Convention on the
Rights of the Child (UNCRC) sets out the fundamental rights of all children and
young people. “Nearly 25 years ago, the world made a promise to children: that
we would do everything in our power to protect and promote their rights to
survive and thrive, to learn and grow, to make their voices heard and to reach
their full potential. The Convention changed the way children are viewed and treated—i.e.,
as human beings with a distinct set of rights instead of as passive objects of
care and charity.” Ironically, Article 33 of the UNCRC states, “You have the
right to be protected from dangerous drugs.”
By encouraging children to believe
they are broken and are to blame for their distress and by medicating them with
powerful drugs we know change brain chemistry, are we taking away their right
to survive, and ability to thrive, be protected and reach their full potential?
At what point in their life might a child question their medication? When they
do, what damage might already have been done? Parents have a responsibility to
learn the truth about antidepressants and their unknown effects on a developing
brain. Does any parent have the right to control the development of their child
with drugs? The reality is that children parked on antidepressants at a young
age become medicated adults. At some point they will make up their own mind
about their medication, might find themselves battling prescribed drug
dependence or they simply might not like the way they turned out.
Meanwhile, back at the FDA, “Kids
just don’t have time to leave their depression untreated. The social and
educational consequences of a lengthy recovery are huge. They could fail a grade.
They could lose all of their friends.” (Child and adolescent psychiatrist
Tiffany R. Farchione, M.D., is the Acting Deputy Director of FDA’s Division of
Psychiatry Products.)
By now, reading this book, we
understand the real potential health and social consequences of choosing to
treat our children with antidepressants. They could lose so much more than “all
of their friends.”
WARNING: “Pediatric
patients being treated with antidepressants for any indication should be
closely observed for clinical worsening, as well as agitation, irritability,
suicidality, and unusual changes in behavior, especially during the initial few
months of a course of drug therapy, or at times of dose changes, either
increases or decreases. This monitoring should include daily observation by
families and caregivers and frequent contact with the physician. It is also
recommended that prescriptions for antidepressants be written for the smallest
quantity of tablets consistent with good patient management, in order to reduce
the risk of overdose.”211
21
THE ELDERLY,
VULNERABILITY
AND ANTIDEPRESSANTS
Our elderly are vulnerable victims of the
system. At a time when they deserve care and social support, why are we
choosing psychoactive medication over human interaction and kindness?
“Treatment of mental disorders among older
Americans has become a major public health need. The number of people over the
age of 65 with psychiatric disorders will more than double by the year 2030,
from 7 million in 2000 to 15 million. The past decade has seen dramatic growth
in research on the causes and treatments of the psychiatric problems of older
adults.”212
Our senior citizens are perhaps the
most vulnerable when it comes to being diagnosed mentally ill. It seems quite
obvious that older people are those most likely to suffer from loneliness,
isolation, sadness, anxiety and the range of feelings which accompany elderly
life and the many changes it presents. Many suffer from insecurity, from stigma
and abuse, ageism, sexism and lack of confidence due to the physical and
cognitive difficulties which come naturally with old age.
Published in the Journal of the
American Geriatrics Society, geriatric mental health leaders wrote, “COVID-19
Pandemic and Ageism: A Call for Humanitarian Care.”213 But don’t our elderly deserve
humanitarian care at all times? Today’s society can sometimes be difficult to
tolerate and navigate for most of us, but instead of providing the elderly with
said “humanitarian care”, why do we choose to treat our elderly population with
antidepressants and other psychiatric drugs?
In 2011, a study published in the
British Medical Journal raised questions about antidepressant risks and the
over 65s. Its conclusions were that taking antidepressants was associated with
increased death rates and other adverse consequences, and that the new
antidepressants may have greater serious risks than those associated with
previous generations of antidepressants. They determined SSRI and related
antidepressants “were associated with an increased risk of several adverse
outcomes compared with tricyclic antidepressants”.
“The average age of participants was
75. Many suffered from other illness, including heart disease and diabetes, and
were taking multiple medications. Nearly 90 percent of patients were prescribed
an antidepressant during the study period. Of those, 55 percent received SSRIs,
32 percent received TCAs, and 13.5 percent received other antidepressants.
Those taking SSRIs had an increased risk of stroke, falls, fracture, epilepsy
or seizures, high levels of salt in the blood and dying of any cause, compared
with those taking TCAs.”214
A UK study in the British Journal of
Psychiatry reported new antidepressant prescribing to over 65s has doubled over
twenty years. This was, despite the fact that the number of people diagnosed
with depression in this age group had changed very little. Professor Anthony
Arthur of the university of East Anglia said “Substantial increases in
prescribing have not reduced the prevalence of depression in the over-65
population. The causes of depression in older people, the factors that
perpetuate it, and the best ways to manage it remain poorly understood and
merit more attention.”215
Older people taking antidepressants
are at more risk of dying or suffering strokes, falls, fractures and epilepsy,
as well as the many other adverse effects commonly suffered in other age
groups. Elderly with heart conditions, diabetes, previous strokes and other
conditions have antidepressants prescribed on top of other medications putting
them at risk of serious adverse drug interactions.
The American Academy of Neurology
study, “Association of anticholinergic medications and AD biomarkers with
incidence of MCI among cognitively normal older adults,” highlighted the adverse
impact of anticholinergic medications on cognition and the need for
deprescribing trials, particularly among individuals with elevated risk for
Alzheimer’s Disease.216
There are so many reasons why it
does not make sense to medicate our elderly with drugs which are not fit for
purpose. Despite the fact they are generally more sensitive to drugs, our aging
population is an easy target for overprescribing. It has been reported
prescribing to the elderly in care homes and assisted living has increased
fourfold with around double the number of women treated with an antidepressant
compared to men; (24.3 percent of all women aged 60 and above). The many
serious potential adverse effects alone which can include, Cognitive Brain
Impairment, dementia, diabetes, tardive dysphoria and worsening of depression,
should make us question prescribing to aging individuals with existing health
conditions.
Millions of us will take our
antidepressant dependence with us into old age. Education is once again key to
supporting us throughout our medication journey. As we become older, we might
be dependent on antidepressants we have taken for many years. A change in
circumstances might put us in a position where we are no longer able to manage
our unrecognized dependence. Care providers might lack knowledge of the dangers
of antidepressant dependence. We might become vulnerable to being harmed by
changes to or withdrawal of medication; it might be increased or withdrawn at
any time, without informed consent. Just as with people in other age groups,
our elderly, when first prescribed, probably do not have a chemical imbalance
causing their depression. What they do generally have is difficulty coping with
life and the changes it presents with growing old. For many, the reality of
their condition might be as simple as one of loneliness.
MDLinx, reports “The newest epidemic
in America now affects up to 47% of adults—double the number affected a few
decades ago.”217
Loneliness is not a mental illness but is certainly being treated that way as
we continue to overmedicate our elderly. It is just one more example of today’s
medicalization of a natural but totally avoidable state we need to prevent
rather than “treat”. “Psychologists, psychiatrists, and social scientists have
known from clinical work over decades that both intellectual and social
engagement help to prevent loneliness.”218 We also know social activity
is positively associated with a decrease in cognitive decline.
Drugs are a cheap and easy option
compared to talking therapies. Talking therapies are very often unavailable,
have long waiting lists or are expensive and doctors rarely refer older people
for therapy. The fact is there is a severe lack of provision of psychosocial
services and interventions for the elderly which is perhaps fueled by our
reliance on antidepressants. There is once again a huge need for a change in
practice when it comes to treating our senior citizens. Treating our ability to
cope with life and calling it mental illness as we get older is both
disrespectful and counterproductive. We need a societal change. Whilst
medication can help some older people, is it time for organizations such as the
National Institute on Aging to rethink their adoption of the “medical model of
mental health” approach? Is it time we look first at the individual and not at
their so called real “illness”, “clinical” depression, “disorder”, or whichever
label fits to make the system easier?
To quote the National Institute of
Aging, “When you have depression, you have trouble with daily life for weeks at
a time. Doctors call this condition “depressive disorder” or “clinical depression”.
“Depression is a real illness. It is not a sign of a person’s weakness or a
character flaw. You can’t ‘snap out of’ clinical depression. Most people who
experience depression need treatment to get better.”219 This is a just one more
example of the damaging, societally accepted narrative we need to change.
22
ANTIDEPRESSANTS,
THE ARMED
FORCES, PTSD AND SUICIDE
The Armed Forces, PTSD, antidepressants and
suicide: don’t those who serve us deserve better?
Around 8 million adults are diagnosed with
Post-Traumatic Stress Disorder (PTSD) during a given year. Perhaps the most
tragic consequences of PTSD are felt by our military.
Throughout history soldiers have
inevitably returned from wars with traumatic memories but until the emergence
of PTSD, they would generally use their personal resilience, community support
and the passing of time to rebuild their lives. PTSD turned military experience
and human suffering into a disease; a disease needing drugs. In what is a
pitiful commercial venture, the pharmaceutical industry and psychiatry see the
military as their target, they take aim and boom... another successful
psychiatric drug market is created and developed. It was one more area of human
suffering ripe for exploitation and medicalization.
The use of psychological
interventions is recommended as a first-line approach for PTSD by a range of
authoritative sources but, in reality, our veterans are usually medicated when
returning from active duty.221
There are four antidepressants recommended for PTSD: sertraline (Zoloft),
paroxetine (Paxil), fluoxetine (Prozac), and venlafaxine (Effexor).
In addition to an initial diagnosis,
the US Department of Veteran Affairs (VA), states; “Most people with PTSD—about
80%—have one or more additional mental health diagnoses. They are also at risk
for functional impairments, reduced quality of life, and relationship problems.
PTSD and trauma are linked to physical health problems as well. These articles
explain the connections among PTSD, trauma and co-occurring mental and physical
health problems.”222
Knowing what we do about the adverse effects of antidepressants and the
prescribing cascade they can cause; is it any surprise veterans are at risk of
so many other impairments and health problems?
Primary Care PTSD Screen for DSM-5
(PC-PTSD-5)224
Description
The Primary Care PTSD Screen for DSM-5
(PC-PTSD-5) is a 5-item screen that was designed for use in primary care
settings. The measure begins with an item designed to assess whether the
respondent has had any exposure to traumatic events. If a respondent denies
exposure, the PC-PTSD-5 is complete with a score of 0. However, if a respondent
indicates that they have experienced a traumatic event over the course of their
life, the respondent is instructed to respond to five additional yes/no
questions about how that trauma exposure has affected them over the past month.
Scale
Sometimes things happen to people that are
unusually or especially frightening, horrible, or traumatic. For example:
·
A serious accident or fire
·
A physical or sexual assault or abuse
·
An earthquake or flood
·
A war
·
Seeing someone be killed or seriously
injured
·
Having a loved one die through homicide or
suicide
Have you ever experienced this kind of
event? YES / NO
If no, screen total = 0. Please stop here.
If yes, please answer the questions below.
In the past month, have you...
·
Had nightmares about the event(s) or
thought about the event(s) when you didnot want to? YES / NO
·
Tried hard not to think about the event(s)
or went out of your way to avoid situations that reminded you of the event(s)?
YES / NO
·
Been constantly on guard, watchful, or
easily startled? YES / NO
·
Felt numb or detached from people,
activities, or your surroundings? YES / NO
·
Felt guilty or unable to stop blaming
yourself or others for the event(s) or any problems the event(s) may have
caused? YES / NO
Miriam Reisman writes, “Complicating the
diagnosis and assessment of PTSD in military veterans are the high rates of
psychiatric comorbidity. Depression is the most common comorbidity of PTSD in
veterans. Results from a large national survey show that major depressive
disorder (MDD) is nearly three to five times more likely to emerge in those
with PTSD than those without PTSD. A large meta-analysis composed of 57
studies, across both military and civilian samples, found an MDD and PTSD
comorbidity rate of 52%.”223
The National Center for PTSD
provides a number of “PTSD Screening Instruments” (brief questionnaires), to
help identify people who are more likely to have PTSD. These simplistic tools,
created with the DSM-5, are very similar to the tools used to screen for other
disorders in the general population. Their primary aim is to diagnose a
condition which needs medication.
Alarmingly, instead of questioning
the current overprescribing, we are seeing more clinical trials to develop and
approve other drugs to treat PTSD. It has become a very lucrative arm of the
pharmaceutical industry’s psychiatric drug market. PTSD is easy to understand
and relate to by anyone who has suffered trauma or an adverse life event and
using it, our military and veterans are particularly at risk of being
medicated, often with serious or fatal consequences.
There have been more than 70,000
veteran suicides since 2006 and given it is widely acknowledged that
prescription drugs can put us at risk of dangerous adverse effects, most
notably that antidepressants and some other medication can raise the risk of
suicide, should we be questioning the connection between the high rates of
prescribing to veterans and number of veterans ending their lives by suicide?
Robert Whitaker and Derek Blumke
published a report detailing VA suicide data which shows an increased risk of
suicide for veterans treated at the VA.225 It also highlights
disproportionately high rates of prescribing to veterans of psychiatric drugs
which we know increase suicide risk. Despite the VA declaring “preventing
suicide among Veterans is the VAs top clinical priority”, Whitaker and Blumke
write, “Its screening protocols have ushered an ever greater number of veterans
into psychiatric care, where treatment with antidepressants and other
psychiatric drugs is regularly prescribed. Suicide rates have increased in
lockstep with the increased exposure among veterans to such medications.” This
of course is the exact same message given to the general public; that suicide
is a public health issue, we need to identify mental health problems, diagnose
them and treat them.
In 2016, the VA published a report
they said was the “most comprehensive analysis of Veteran suicide in our
nation’s history.” They divided VHA-using patients into four subgroups:
Undiagnosed and Untreated (for a mental health or substance abuse disorder),
Undiagnosed and Treated (with either a psychiatric drug or non-pharmacologic
treatment), Diagnosed and Untreated, and Diagnosed and Treated.
The results show those without a
diagnosis who got mental health treatment were more likely to die by suicide
than those without a diagnosis who did not access such treatment. In 2014,
those who got treatment died at twice the rate of the “untreated” group. Most
concerningly, those who had no diagnosis but received mental health treatment
were more likely to die by suicide than those with an untreated diagnosis. The
findings show exactly why mental health treatment is doubling the risk of
suicide, something we already know from clinical trials.
More than 53,000 veterans died by gun
suicide between 2005 and 2016 and Americans are quick to point the finger at
the accessibility of guns.226
But there are a multitude of factors contributing to suicide. Many are quick to
blame the access to guns as a cause of the high rates of suicide in the US, but
few are prepared to acknowledge the overprescribing of prescription drugs as a
key factor.
“It’s a daunting list,” Dr. Sue
Sisley, a psychiatrist in Phoenix, told The Huffington Post about the
staggering number of medications available for PTSD. The Department of Veterans
Affairs’ national formulary is a catalog of drugs and supplies commonly
prescribed by VA doctors overall and it contains more than 1,500 items. “When I
show this list to our military veterans, they were completely nauseated because
they have frequently been the target of so many of these medication trials,
Many of the medications used to treat serious PTSD symptoms such as anxiety,
depression, flashbacks and insomnia come with risky side effects, especially
when combined with one another. One of the most dangerous is an increase in
suicidal thinking.”227
But are things changing and are
questions starting to be asked about prescription drugs and veterans’ mental
health treatment? Mad in America has launched the Veterans, Service Members
& Military Families Initiative, to help the community become better
educated and to assist service members, veterans and their families to identify
alternatives to the dominant drug-based model of mental health. The Veterans of
Foreign Wars (VFW) and the American Legion are also looking at antidepressants
and the suicides of service members, veterans and their families.228
A new approach, Warfighter Advance,
founded by Dr. Mary Neal Vieten is leading the way in offering an alternative
way to help veterans. Its aim is “100% successful reintegration &
resilience of the Warfighter and a world where a traumatized Warfighter is
fully restored in a non-medical context.”229 It openly rejects the medical
model of treating trauma with medication and recognizes the need for informed
consent to mental health care. It offers tools to help with post-deployment
life empowering military personnel (active or veteran), to help build support,
relationships and the confidence to live meaningful lives.
“After a careful analysis of the
risk-benefit ratio, we reject all ‘mental illness’ labels for the Warfighter
and, likewise, reject the use or usefulness of psychiatric medications in the
process of Warfighter reintegration. We acknowledge the devastating
implications of these labels and ‘treatments’ for traumatized individuals in
general.”
“Warfighter Advance changes the
trajectory of the warfighter’s post-deployment life, so that rather than an
existence characterized by an endless cycle of mental illness diagnoses,
medications, medical appointments and disappointments, the warfighter has a
life characterized by pride, productivity, healthy relationships, continued
service, and advocacy for the same outcomes for their fellow service members.”
The 20 veterans who die every day by
suicide in the US are clear evidence of the urgent need for change. Veterans
deserve our current societal approach to “suicide prevention” to be questioned
and we need to acknowledge screening, diagnosis and treating with
antidepressants are often a precursor to suicide.
It is time to change the predominant
messages such as those of “The American Foundation for Suicide Prevention” who
openly tell us “ninety percent of people who die by suicide have a mental
disorder at the time of their deaths.” Instead of questioning how many are
taking mind altering psychoactive antidepressants with a black box warning for
suicidal ideation, they continue to promote medical diagnoses and treatment as
a way to reduce suicide. They continue to propagate the message that medication
is best. “The most common disorder associated with suicide, the Foundation
states “is depression, an illness that goes undiagnosed and untreated far too
often.” It advises the media to “convey that suicidal thoughts and behaviors
can be reduced with the proper mental health support and treatment.”230
What would happen if we were to see
a massive reduction in the mental health messages we constantly hear,
reductions in the diagnosis of the disorders accompanying them and reductions
in the prescribing of the harmful antidepressants some of us unnecessarily
swallow? What would happen if we all became “Warfighters” and took a different
approach to changing and adapting to the challenges in our lives? Paradoxically
speaking, the more drugs prescribed the more suicides there will be... but we
might not hear this message from government bodies or the medical profession
any time soon.
PART 5
Patient Experiences
“Next time you see a TV commercial for a
prescription drug, remind yourself that you know nothing about medical treatment
and that everybody who made the commercial has a financial interest in your
future behavior.”231
T |
HE PHARMACEUTICAL
INDUSTRY
is one of the biggest advertising spenders in the United States. (The US and
New Zealand are the only two developed world countries to allow pharmaceutical
direct to consumer advertising (DTCA) on TV.) In 2017, in the New York Times,
Joanna Kaufman asked us, “Think You’re Seeing More Drug Ads on TV? You Are, and
Here’s Why.”232
In 2018, Jacob Bell wrote, “Just considering television, 187 commercials for
about 70 prescription medications have collectively aired almost half a million
times since the start of 2018. And to do that, drug companies shelled out $2.8
billion, according to marketing analytics provider iSpot.tv.”233
November 2015, the American Medical
Association (AMA) called for a ban on direct-to-consumer advertising of
prescription drugs and medical devices, including television advertisements.
Their main justification was they “encourage patients to ask for costlier drugs
that may not be appropriate for them”!234 “A new STAT-Harvard poll
indicates that the AMA’s position has clear majority support from the American
public. According to the poll, 57 percent of Americans favored removing pharma
ads from TV; 39 percent were opposed. 44 percent of those polled also said the
FDA should be allowed not to approve a new drug if it considers the price too
high.”235
The drug commercials usually tell a
specific type of personal story. The character is of course an attractive if
supposedly ailing individual with a smile to die for. They are being saved by
the drug which is enabling them to live perfectly in their ideal suburban
world. None of this is real, of course. Actor patients with fake illness seeing
actor doctors with the air of George Clooney. It’s all polished, idealistic and
any “side effects” are delivered in rapid fire, accompanied by text requiring
binoculars. We have no idea which “side effects” are the most dangerous, the
severity of them or the frequency of them.
As the editors of Scientific
American tell us, “Peddling pharmaceuticals on TV is a lousy form of health
education, and it can also drive up medical costs.”236 It is, without doubt, the most
irresponsible way to educate consumers about medication, in particular
antidepressants and other “psychiatric drugs”, portraying the wonderful life we
can all have if we just swallow that pill. All our stresses, anxiety and
sadness will disappear when we buy into the idea of having shiny hair, a
perfect apartment and an adoring partner. As the commercials entice us, the
need to actually understand and learn about the medication before we take it
seems irrelevant. The unrealistically simple yet persuasive messaging is all it
takes for us to visit our doctor with the name of that medication firmly
planted in our mind.
The pharmaceutical industry wants us
to believe their commercials empower, educate and ensure we have confidence in
their products, when in reality they are selling us drugs we can often do
without. Their advertising is one of the most effective drivers in the
medicalization of the United States and works with screening and diagnosing as
part of their billion-dollar marketing toolbox.
The juxtaposition of the actor
patient and the real-life patient is frightening. We are sold a quick fix and a
miracle cure when in reality, we often consent to a medicated life of adverse
effects, prolonged and additional illness and sometimes death. We know it is
impossible to predict how we will react to antidepressants and nowhere in any
antidepressant commercial are we told this. Some of us might find them useful,
if taken for the shortest time but many of us will find the drugs we buy into
do significantly more harm than good. Eventually we will need the information
we should have received before we agreed (without informed consent) to take
them. It is usually only when things go wrong that we seek more information,
and we look for help and support.
Anecdotal evidence is the best
evidence we have when it comes to learning about the sometimes devastating
effects of antidepressants. The personal experiences of people worldwide who
have experienced a life “antidepressed”237 tell a very different story to
the ones we are sold in the TV commercials. These are real people who believed
what they were told by the medical profession, took antidepressants as
prescribed and whose lives will never be the same again. Such experiences were
looked at in the research study, “The Patient Voice”, published in Therapeutic
Advances in Psychopharmacology.238
Amongst their findings, “A total of
97% of respondents were offered a prescription on their initial consultation
with a doctor, 5% reported being offered talking therapy, and 0.6% were offered
lifestyle advice (with some patients offered more than one option).”
“When patients reported side effects
to their physician, the response of their doctor varied widely: 32% tried an
alternative drug, 35% added another drug, 28% adjusted the dosage, and in 21%
of cases the doctor dismissed the idea that the side effects were related to
the prescribed drug.”
“The researchers found the following
common themes:239
A lack of information given to
patients about the risk of antidepressant withdrawal.
Doctors failing to recognize the
symptoms of withdrawal.
Doctors being poorly informed about
the best method of tapering prescribed medications. Patients being diagnosed
with a relapse of the underlying condition or medical illnesses other than
withdrawal.
Patients seeking advice outside of
mainstream healthcare, including from online forums.
Significant effects on functioning
for those experiencing withdrawal.” The study shows the failure of the medical
profession to listen to patients. It shows their lack of knowledge about
antidepressant adverse effects and withdrawal. These are the professionals we
rely on to help us make decisions about our healthcare and it is obvious, when
it comes to our mental health, we need and deserve better. We must challenge
our preconceived societal ideas and beliefs about antidepressants and learn from
the experiences of others. We need to understand real-life evidence paints a
very different picture to the one often portrayed by the medical profession and
the pharmaceutical industry.
*Up
to three answers recorded per petition responder. Percentage is equal to
percent of 158 responders who mentioned each answer.
Warning: The following patient testimonials
feature sensitive topics, including suicide, substance-related trauma and
emotional distress. This content may be upsetting for some readers and may
exacerbate underlying symptoms. Please use your best judgment when proceeding.
“I am writing this letter, so you will
understand the harm and deaths from antidepressants. On September 8, 2011, my
42 year old beloved son took his life. I couldn’t wrap my mind around how this
could even be true. He wasn’t suicidal in his life. He lived across the street
from me and I saw him all the time, I would know as a mom, if something was
bothering him. As you can probably imagine, I asked my daughter in-law every question
I could think of, to get a reason to WHY. If you lose a family member to
suicide, you want to know WHY!
Everything I asked her, she said no
to. Finally, one day I called her and asked if he was taking any medications
and she said yes, Zoloft (sertraline) and Wellbutrin (bupropion). I asked her,
was he feeling depressed? She told me in 1999 he saw his PA and was diagnosed
with generalized anxiety; that through the years, he tried to get off them,
because of the side effects he suffered with, only to not be able to do it.
Then, in the spring of 2011, he told his wife he wanted his life back and
called his doctor to get tapered off them. I have had to learn the hard way
that doctors taper their patients too fast. I’m sure you have heard this from
most of the people who have written to you.
A few months later withdrawals hit
him, which is typical with antidepressants. More anxiety and not being able to
sleep. This probably caused him to feel depressed, and so he called his doctor
to go back on them, not knowing it was the antidepressants that caused his
problems. NINE DAYS AFTER RESTARTING ZOLOFT (SERTRALINE) HE SHOT HIMSELF! I
would love to tell you about his day before he suddenly and so out of character
ended his life, leaving a widow and two children fatherless. Something needs to
be done, as too many people have taken their lives or other lives.”
—From Petition Ref LLLLLLLL
______________________
“Everyone has some emotional problems, of
varying degrees. I sure had my fair share since I can remember, all had a root
cause, all had a reason. But I did not know how to deal with them, no one was
able to guide me, to comfort me, teach me proper coping skills. I thought, I am
different, something is wrong with me. Lousy childhood, abandoned by father,
further inept parenting, lousy husband, the confusing life-circle continued.
What was wrong with me? Because I cried too much, asked too many questions,
received stoned silence, insomnia, fearful of dark shadows that crept in the
night which sometimes were really not shadows at all. I tried to verbalize
these feelings, fears, anxieties, challenges, because I wanted to connect,
talking and having someone to listen, to believe, even parents, even husband,
even doctors, put up barriers, they did not want to hear, nor did they know
what to say. “Let’s just shove some pills down your throat.”
Mother said, “You are the crazy one,
you are seeing a psychiatrist, nothing wrong with me, it is something wrong
with you.” I shut myself off, feeling ostracized, feeling like a bad person. So
thus it went on, post-partum antidepressants that just made me so drowsy, I
could not care for my young baby, unresolved marital situation that ended in
divorce. If I could only talk, if only someone would listen, if only someone
would validate me and my feelings, if only I was told, that it was all part and
parcel of living, instead of being “tranquilized”, mouth was so dry, head
foggy, wobbly legs, I could not speak, if I could. I walked around in a daze,
barely participating.
Later on there was Prozac, a touted
miracle drug (got bad press because caused some suicidal deaths) and that was
ignored, and then after ten years, Cymbalta, supposedly another miracle drug
for its wonderful chronic pain alleviation. And then came my decision to
withdraw from Cymbalta after being on it for 8 years. Nightmares, physical
feelings of one leg draining into the other, someone clawing at me in the
middle of the night, noises in my ears, could not cry was numb, extreme
dizziness, nausea, insomnia. After 4 years, still feeling spacy. Over three
years, lying around on the couch, could not think properly, had no incentive,
isolation, difficulties in socially, could not relate to people. Yes, doctors,
how arrogant, egotistical, incompetent, monstrous of you to ignore your
patients who many times just want someone to talk to, to be validated.
Automatically pull out that pen and prescription pad, “yes, we know what will
fix you, we will give you a tablet” that will calm your down, make you numb,
keep your brain in limbo, masquerade your feelings, keep them hidden out of
sight, we are used to giving out pills, that is what we do, medication will
help you. And we know about side effects; all medications have side effects;
but the good of medication outweighs the bad. “We have given you something, we
have done what we do best, and we have fixed your problem.” Many say they
receive no cutbacks from the pharmaceutical companies, all those free samples,
writing pads, calendars, coffee mugs, travel benefits, and what else? So you
completely screw up my brain so it was upside down, every day trying to gain
some sort of equilibrium. Having no energy, no initiative, disinterested,
trying so hard to valiantly stay afloat, being embarrassed because of lack of
motivation called laziness, gave up on my poetry writing, artwork, just wanted
to sleep, bright lights, loud noises, harsh smells, seems like my mind was all
twisted up, like strings of Christmas tree lights all tangled, desperately
trying to keep alight, when the electrical impulses were delayed, detoured,
weak, fragmented, nothing ran smoothly, nothing lit up all at once in unison,
some were lit, others never fired, never gave a glow. I walk around like a
zombie, afraid to make any abrupt movements fearing that I might just splinter
into pieces and be blown away by the least bit of breeze.
I am only one in thousands of
people, and even very young people whose lives have been changed, and, not for
the better, some people have even more horrendous effects from being on certain
drugs, and end up ending their lives, or ending others. Doctors are inept in
treating patients in the adverse side effects of medication especially in
withdrawal, have no idea, and then prescribe other drugs to minimize those side
effects. It is imperative that doctors need to be further educated in
withdrawal/weaning from medication. It is all very complex I know, and
prescribing drugs upon drugs without the overall health of the patient long
term is not taken into consideration, fixing the problem now, can often lead to
more severe problems later on without careful monitoring.”
—From Petition Ref S
__________________________
“In July 2003, at the age of 45, I
experienced my first major depression. I started taking 40mg. of the
antidepressant Paxil a day. By September, I was feeling mentally healthy again.
After forgetting to take Paxil for a few days in February 2004, I weaned myself
off the drug. I started to feel depressed again in July. My symptoms included
insomnia, increased anxiety, rapid weight loss, low concentration and a lack of
energy. I put myself back on 40mg of Paxil a day.
A few days after I started taking
Paxil again, I was having suicidal thoughts. I thought I could get rid of the
thoughts and recover more quickly if I increased my dosage. On July 17, I
started taking 60mg. of Paxil a day. Three days later, I planned my suicide. I
went from planning my suicide to planning a murder-suicide to planning a
murder. On July 31, 2004, I killed my 11-year-old son Ian. I was charged with
first-degree murder. In November 2004, I was diagnosed by one of the leading
forensic psychiatrists in the world as being in a “major depression” with
“psychotic episodes” when I killed Ian. In May 2005, his assessment was
supported by another leading forensic psychiatrist, who was hired by the crown
attorney. On September 30, 2005, I was judged to be ‘not criminally responsible
on account of a mental disorder’ for murdering Ian. I received an absolute
discharge from the Ontario Review Board on December 4, 2009.”
—From Petition Ref QQQQQQQQ
__________________________
“I cannot include most of what happened to
me whilst taking and coming off the prescribed antidepressant as it is too
traumatic for me to revisit. My life has been destroyed by taking a prescribed
antidepressant. Serious side effects and adverse reaction was not picked up by
doctors. My mental and physical health deteriorated over the three years I was
on it and it all came to a head when I hit tolerance. My body and brain just
could not tolerate the drug any longer and hell broke loose and I lost any kind
of a normal life altogether. I am a mother to two children and a wife to my
wonderful husband who; if it wasn’t for them I would not be here. The symptoms
and experiences I have had to endure as a result of taking a prescription
antidepressant have been inhumane and most of it -I couldn’t find words for. My
children have lost their mother in so many ways. I can no longer function like
I once did -physically and mentally. Most of my days are spent lying down on the
sofa or in bed because the pain, exhaustion, fatigue, head pain or depression
is too much. I suffer cognitive problems which affect me in so many ways. I
lost my emotions altogether—I cannot feel love, happiness or any good emotion.
No connection to life. I have become sensitive to chemicals, foods and have
been advised to stay away from all prescription drugs as they would have a
negative effect on me. I have had to endure psychosis, suicidal depression and
suicidal urges. The most horrific mental torture one can imagine. I would never
have thought those states were possible. I can no longer exercise which is
something I loved to do prior to this ordeal. I have lost friends and any kind
of social life. It has been devastating for me and my family. I cannot believe
what my life has become. I believe if my doctor had been aware of the dangers,
informed of adverse reactions and long term use dangers this would not have
happened.
There was no informed consent when
he gave me that first prescription. I believe if I had been told, I would never
have touched them. I had anxiety induced stress from being in a stressful job,
a mother to two young children and having a husband who worked away from home.
I was still a happy, healthy young women with a life ahead of me. Now I have no
idea what my future holds. I am nearly four years off the antidepressant and
still have no signs of recovery. We need to be believed, validated and
supported. We didn’t ask for this. No one should ever have to go through what I
and many others have. Please help this happen. Many other lives could be saved
and many helped. Thank you for taking your time to read this.”
—From Petition Ref PP
__________________________
“I had no experience with psychiatry till
the birth of my second child. I was admitted to hospital in a state of crisis.
My family doctor had not understood the development of my postpartum
depression. She prescribed an SSRI which, with any exploration, would have been
counter indicated for me. The immediate outcome was a suicide attempt when I
jumped at a subway train after ten or twelve days. Twenty three years later I
still need a wheelchair, an accessible home, so very many other things as well.
I consider myself lucky because I got to be a stay at home mum. I did live. Not
everyone survives. I understand from various research resources that suicide is
an unsurprising outcome from SSRIs. I believe that SSRIs need to be eliminated.
I do not like psychiatric drugs, however I do use them. They slow me down,
cloud my brain and interfere with my life. But I am alive.”
—From Petition Ref BB
__________________________
“I have been severely harmed by being
prescribed an SSRI at the age of fifteen for situational anxiety. I tried to
withdrawal ten years later with severe withdrawal and as most doctors do not
recognize withdrawal my dose was increased and I had to continue taking it.
Fast forward another ten years and I was co administered another drug for an
infection and developed serotonin syndrome and severe side effects. I have been
diagnosed with neuroleptic drug induced akathisia and extrapyramidal side
effects from Zoloft.
Zoloft has completely destroyed my
life. Since this drug interaction two and half years ago and the continued side
effects of this drug I have gone from working and studying to being completely
incapacitated. The medical profession have absolutely no idea about the severe
side effects caused by these drugs or withdrawal. The only solution they seem
to have is increasing the dose or prescribing more drugs.”
—From Petition Ref FFF
__________________________
“For those of us who did not suffer from
immediate adverse reactions from taking these drugs, many go on to inflict the
chemicals into their body and brain while they live ‘something of a life.’
During this time, they are shielded, tooled up, protected from the stresses and
strains of life (although what they are also shielded from is experiencing deep
joy and heartfelt passion that can only be felt from the seat of a person’s own
authentic emotions). They are numb and impervious to making proper connections
with people and as such, this can cause great distress in their relationships
and personal life.
A parallel to this that is worth
pointing out is that if a person walked into a room of 10 people with a knife,
and justified it as a protective measure, he would be considered the lowest of
the low. He is tooling himself up where he can cause huge harm to people with
impunity and the surety that he cannot be harmed in the same way. Mind altering
drugs do a similar thing... a family member told me often that when I took
these drugs, I had them in tears many times with the things I’d say to them.
This next proverb is one that speaks of the importance of acting independently
and deciding your own fate emotionally and spiritually. It indicates how it’s
important to meet life’s challenges head on, the ones that are put at our feet,
because they are put there for a reason. Probably because these are the lessons
that will equip us to learn the lessons we need to and to become the very best
version of ourselves.
The Establishment however, cares
nothing about your spiritual and emotional growth...what it does care about is
your ability to ‘get over it’, get tooled up and get back to work and
contribute to the coffers! Here is the American proverb by Ted Halpern: “Love
many... trust few... and always paddle your own canoe!” I’d rather paddle my
own canoe (poorly, even!)—going into waters that are less than comfortable, and
encountering the people and experiences that will teach me the lessons I have
to learn, so I can become the best version of myself—than have a drug pusher
strap the chemical equivalent of a jet engine onto my undercarriage, ripping
the hull to shreds as I tear through tranquil waters and have them call me a
medical success story.
My father died when I was 14.
Shortly after this, our 16 year old beloved family dog died in front of me
without any chemical euthanasia while I was in the house alone. It took about
an hour for him to die. I was transfixed yet traumatized at the same time. A
year and a half later, I split with my childhood sweetheart who I’d been with
for 2 years; I was a teenager, hormonal, with a sensitive disposition.
There is no record of ANY of this in
my medical notes, yet my memories of this time are vivid. The next 30 years
were spent numb, insulated but functional, other than when I forgot/stopped/or
tapered the drug.”
—From Petition Ref GGGGGGGGG
__________________________
“Our daughter Catherine died in November
2010; she was 29. She was given a cocktail of psychiatric drugs over a period
of 5 months and sadly took her own life. She experienced adrenal exhaustion
after returning from a 6-month world trip in April 2010. She had jet lag and
had been only getting 2 hours sleep a night for weeks. Her wedding in Greece
was to be the 2nd of July and she had a breakdown 2 weeks before we were due to
fly out to Santorini.
There were many stressors also
besides the wedding preparations. Catherine was diagnosed with MS in January
2009. She was given Benzodiazepines initially for anxiety and then prescribed
Escitalopram for the anxiety and to help her sleep but that’s when her
nightmare began.
After being on that drug for just
over 2.5 months she had bought weed killer with the intention of killing
herself. We requested—and Professor Andrew Herxheimer kindly wrote—a report for
the coroner. From my understanding of his report, ‘escitalopram and its almost
identical predecessor citalopram are linked with suicidal ideas and behavior’.
And that in his conclusion, ‘We cannot ask Catherine what made her kill
herself, but it is very possible and even likely that her suicidal thoughts and
feelings were induced by aripiprazole and mirtazapine. Their effects would have
been additive.’
More and more drugs were added. It
wasn’t till after she died that we began to find out about the drugs which
Catherine was taking. We realized soon after, that it was probably the cocktail
of these powerful mind changing drugs that lead to her death. Drugs Catherine
was taking prior to her death on 24th November 2010 were: 1) Aripiprazole 20mg
mane, 2) Mirtazapine 45mg nocte, 3) Procyclidine 5mg tds, 4) Haloperidol 5mg
mane and 10mg nocte, 5) Diazepam 5mg pm to tds, and 6) Zopiclone (as needed).
We undertook research about these
drugs. The more we read, the more we were shaken, with ultimate anger building
inside us. All she needed was rest and sleep. Professor David Healy has
highlighted the adverse reactions to some of the drugs in his open letter to
coroners in general. Before the inquest, I received a report prepared by the
expert witness from the coroner. The main emphasis seemed to have centered
around Catherine’s MS. He concluded that MS was the main factor in Catherine’s
depression and suicide. He claimed that she had an MS relapse. Professor
Scolding, who was Catherine’s neurologist, confirmed that Catherine never had a
relapse. In fact, all the claims made by the expert witness about her MS were
totally rejected by Professor Scolding, who is an expert in his field of
neurology, and who was also treating our daughter. The expert witness was
giving his opinion about Catherine’s MS, which is a neurological condition, yet
he was contradicting Professor Scolding’s opinion, who is an expert in
neurology.
The expert witness never saw or met
our daughter and I find the claim, that it was the MS that made Catherine
depressed and have suicidal ideas, astonishing. However, Professor Scolding did
see Catherine, and said in his letter that he was ‘always impressed by how well
she seemed to adjust to the disorder and by her courage and strength of
personality.’
Our daughter was a highly
intelligent girl, she was loving, kind and gentle. She always showed much
concern for her family and friends. She loved life and was looking forward to
her future. Catherine had no history of depression or any mental health
problems at any time in her life. She was always upbeat and determined and
showed such a lot of courage even after the diagnosis of MS. It was totally
alien to her to think or even contemplate suicide. The expert witness in his
conclusion cited the key findings from a paragraph from “CSM Expert Working
Group on the Safety of SSRIs 2008”. It states that: ‘There is no clear evidence
of an increased risk of self-harm and suicidal thoughts in young adults of 18
years or over.’ The report was published in 2004 and not 2008 as he claimed. It
is out of date because that finding no longer applies. In 2008, new trials were
carried out to show that it now extends to 25 years and not 18. In effect, he
reproduced a finding that no longer applies. I personally find this misleading.
At the inquest, I challenged him on
this but he insisted it was 2004. He appeared flustered. The expert witness
report also stated: ‘On 1st November, the dose of aripiprazole was doubled to
20mg when she was last seen by the psychiatrist. It was felt that she was
improving.’ This was contradictory to our observations of our daughter.
Catherine was deteriorating and she was thinking about suicide. The team was
contacted on Friday, the 29 th of October 2010, and this was pointed out to
them. This was after Catherine visited a police station with the delusion that
she thought she did something wrong. It is unlikely that the following Monday
(1st November 2010) she would have improved. Indeed, my wife was staying with
Catherine at the time. There was certainly no such alleged improvement. In
fact, quite the opposite: I saw Catherine on 13th November and I was shocked to
see how much she had deteriorated. She was agitated, shuffling as she walked. It
was evident she had akathisia. Akathisia is the extreme inner restlessness
which can be caused by antipsychotics and antidepressant drugs. The affected
person feels tortured from within and these drugs can contribute to or directly
cause or lead to suicide.
On the morning of the day Catherine
died, she had an appointment with the Early Intervention Team. They had knocked
on her door, received no reply and left. No precautionary attempt was made to
contact someone which would have aroused suspicion that something was wrong.
Depending on the time involved, this may even have saved her life. Indeed,
Professor Herxheimer informed me that in his opinion, the level of care that
Catherine received was INADEQUATE. I pointed this out, together with other
detailed responses that I made about the expert witness report. I wrote and
sent two lengthy and detailed reports to the coroner.
They both took extensive time and
research from various sources, including articles written by experts who are at
the fore front of pharmacology research of these psychiatric drugs. Both of my
reports were also discarded by the coroner. The coroner continued and made a
despicable verdict of suicide. We were hoping for a narrative verdict. After
the inquest I wrote to the MHRA, who published ‘Report Of The CSM Expert
Working Group on the Safety of SSRIs.’ Indeed, they confirmed it was 2004, thus
showing that the claim made by the expert witness, which he emphatically
defended, was wrong.
One drug that Catherine was
prescribed was escitalopram, which the expert witness gave his opinion on. At
the beginning of the hearing, the coroner’s officer, when reading out her
report, said that Catherine had a history of depression. I was taken aback but
too upset to respond to this. I had lots to think about and I was certainly not
accustomed to court hearings. I made it clear that prior to June 2010, when
Catherine had a breakdown, she had no history of depression. When someone says
this person has a history of depression, one immediately envisages many years.
This is totally false. So what was meant by ‘she had a history of depression?’
I wrote a letter to the coroner pointing out all of the above, together with
evidence. She wrote back and said she couldn’t comment on the points I raised,
and that her decision remained.
In summary Professor Herxheimer and
Professor Healy have jointly written a paper titled ‘Case Histories as
Evidence,’ which has been published in 2012 by International Journal of Risk
& Safety in Medicine. It explains how it is that many courts have not
adequately considered prescribed drugs as a cause of death which I believe to
be a very sad state of affairs.”
—From Petition Ref AAAAA
__________________________
“I was prescribed an SSRI antidepressant in
1996, at the age of 41. I went to the doctor complaining of intermittent
insomnia when I was away on business, plus PMT. I came away from the
consultation with a diagnosis of being on the edge of a ‘clinical depression’
and clutching a prescription for a drug which I was assured was not addictive.
I was absolutely not on the edge of a nervous breakdown (I had to look up the
meaning of clinical depression) and Seroxat turned out to be most definitely
addictive.
However, when my doctor stated these
facts, telling me I had a chemical imbalance in my brain (also untrue), I
believed him absolutely. Dr. David Healy, in his book ‘Pharmageddon,’ describes
how in the mid-90s, the drug company marketing teams were telling doctors that,
for women, a critical marker for depression was insomnia. Seroxat was the new
non-addictive solution, rather than a short course of sleeping tablets, which
is how this problem had been handled up to then (and what I was expecting to be
given).
Instead, I ended up with a strong
neurotoxic drug which has damaged my health—complete overkill for the problems
I presented. This has happened to many people, particularly women. What
followed was years of trying to stop the drug and failing. At first, I thought
I was terribly ill with a major anxiety disorder. Eventually the penny dropped
that I was experiencing withdrawal, which each time I stopped the drug would
give me symptoms of insomnia, anorexia, indescribable anxiety, phobias, the
list goes on. There was never any formal acknowledgement from my doctor that
withdrawal existed or agreement that that was what I was experiencing. My only
recourse was to take the lowest dose I could to keep the withdrawal at bay. I
had to keep taking it in order to function.
In 2008, I was found to have
osteoporosis, a side effect of Seroxat as noted in the patient literature. In
2009 I developed a movement disorder. I lose voluntary control of my body and
jerk violently as if I am having an epileptic fit, although I am awake. It is
deeply unpleasant. This is considered by the neurologists I have seen to be
either Medically Unexplained (MUS) or a Functional Neurological Disorder (FND).
Most I have seen will not engage with me in the possibility that nearly two
decades on an SSRI could be the cause. One neurologist was enlightened enough
to consider it as an option and agreed to refer me to Dr. David Healy in North
Wales, who is an expert on SSRIs and Adverse Drug Reactions. His diagnosis was
clear and immediate on hearing my story—an ADR between Seroxat and Alendronic
Acid (for osteoporosis). He has seen the same movement disorder due to the same
ADR in other patients before and since.
In 2013, I decided I had to stop the
drug, whatever the withdrawal consequences, in the hope that if I did the
movement disorder might stop too. I have been through four terrible years of
indescribable withdrawal symptoms, and I am coming out the other side. I now
have a dysfunctional nervous system, I still have the movement disorder, and I
have a dysfunctional digestive system which prevents me from eating a number of
foods or taking any supplements or drugs. My nervous system responds to any
drug I try to take by making me jerk violently.
Where government funding is going at
the moment seems to be purely into drug misuse services. There is no
recognition at policy level that patients who have become dependent on drugs
which were taken wholly in line with their GPs prescribing guidelines require a
different approach in order to withdraw from these dangerous neurotoxins. It is
exemplary that society puts so much money and effort into helping people who
misuse street drugs.
However, we who did nothing other
than believe our doctors and follow their advice deserve better than to be
expected to line up at a drug misuse center and be counselled to come off a
benzo or SSRI in the same manner as one would a street drug. It can take months
or even years, depending on the length of time it has been ingested, to
withdraw from a prescribed benzo or SSRI.
It is imperative that appropriate
tapering guidelines become available UK wide. My experience is, and my
expectation continues to be, that any time I need access to NHS services my
issues are distorted by the view that I took an SSRI for 17 years in total and
therefore I have a history of ‘mental illness’ which affects my physical health.
What I want is for any nurse, doctor, specialist, or consultant to look at my
records and say, as a matter of routine, ‘yes, after long term use of an SSRI
your physical body has been affected at a number of levels and we need to take
that into account when treating you.’ Please help us get that level of
recognition within the medical profession. Our experience is that they don’t
want to know, they don’t want to believe us and ‘it’s all in our minds.’ Again,
I will say—we deserve better.”
—From Petition Ref ZZZ
__________________________
“I have had anxiety from a young age but
always tried my best to carry on with things. I completed school and was
working. But as I got older my anxiety got worse. My problem, and what caused
my anxiety was bowel issues. I was scared of needing the toilet when I went
out. This led me to avoiding places and would go out at certain times when
traffic wasn’t bad so I could get to my destination at a quicker pace. I went
to the doctor about it as I was starting to have panic attacks and knew I
needed some kind of talk therapy. This was never offered to me and the
medication 20mg citalopram was given, I was told to take it every day. No
warnings about side effects or withdrawals where given.
After about a year spent on 20mg, my
anxiety didn’t change, it was still there but I kept taking it in hope that it
would work eventually. After a year had passed I went to see my doctor again
and was told to increase to 40mg. Over that year on the 40mg my anxiety
increased and got worse. I also developed a slight tremor and the panic attacks
were more frequent and longer lasting. This then started to interfere with my
job. I was a care worker for adults with autism and challenging behavior. I
loved my job but part of it was taking them out to do activities. I struggled
continuously with panic attacks one after the other. I then could not cope and
went on to night shifts so I didn’t have to go out anymore. Went back to the
doctors and was swapped straight onto sertraline/Zoloft 100mg. Nothing got
better it just kept getting worse, I was dizzy all the time my migraines were
constant; life was a mess.
I went back to the doctors and was
then put on to the highest dose of 200mg. I stuck this out for another year
with nothing getting better, just getting worse, but I listened to the doctors
that it was just my anxiety. By March 2016 I had had enough; I had to quit the
job I had been in for the last 8 years, my life was a mess, my body was a mess.
I had constant tremors and migraines and I had now gained another illness on
top of it all—agoraphobia. I was petrified of going out of the house because I
was so scared of my panic attacks by this point. I went from a girl who would
have anxiety when having to go on long journeys to a girl who had panic attacks
over and over again in my own home.
March 2016, I spoke to the doctor
again and was swapped onto 15mg of mirtazapine. Taper schedule was only a month
from 200mg of sertraline. I began to take the mirtazapine and after about two
days I started to feel very restless in my body but I kept taking them as I
knew it takes a while to get into my system. After nine days my eyesight went
and my whole left side of my body went numb like I had been given anesthetic. I
thought I was having a stroke or a heart attack. After half an hour it got no
better so I rang the paramedics. They came out and did an ECG and told me
everything was ok but they would like me to go into hospital. I couldn’t as my
agoraphobia was that bad; I could not leave.
After a while my eyesight came back
but I was still completely numb down my left side. The following morning, my
face was still numb but I continued to take the mirtazapine for 5 more days. As
the days continued I became more restless internally and felt very dizzy and
numb. I phoned the doctor again and they told me to stop them and go on to 20mg
of fluoxetine. After the very first dose I could not keep still I was pacing
the house day and night in a constant panic attack, what felt like adrenaline
coursing through my whole body. As the days went on it got worse and worse I
was convulsing and twitching I didn’t sleep for two weeks straight as every
time I tried to go to sleep I would be jolted awake and would have this
compulsion to pace. Fourteen days I lasted on the fluoxetine, and I was
petrified to put anymore in my body. I stopped and did not take anything after
that. It has now been 10 months since this point and it has been absolute hell;
my body is a complete mess. I have had these symptoms constant for the whole 10
months and it doesn’t seem to be getting any better:
·
Constant tingling all over my body,
especially worst when I first wake up and when I’m trying to sleep. Feels like
I’m plugged into the electric.
·
Akathisia, cannot sit still, an electrical
current running through my body 24 hours a day every day. I pace back and forth
around the house as I cannot keep still.
·
Burning skin, like somebody is holding a
match under my skin at all times, yet my hands and feet are numb and cold.
·
Bloated beyond belief.
·
Dizziness; I don’t know what it feels like
to not feel like I’m on a rocking boat in the middle of the ocean.
·
Itching, like there are millions of bugs on
my body. Sometimes it feels like they are trying to get in, sometimes it feels
like they are trying to get out.
·
Body jolts, most annoyingly at night when
I’m trying to sleep. It’s like some annoying farmer is prodding me with a
cattle prod.
·
As soon as I eat, it feels like my body
goes into more dark places; anxiety levels increase
·
Small amounts of food send my blood sugars up
from 5.5 to anywhere between 8 and 10.
·
Absolutely petrified to eat anything too
sugary.
·
Urination approximately 4 times in an hour
every hour. Bladder always feels full and heavy.
·
Body temperature always low (34.9°C) even
though I don’t feel cold.
·
Clenched jaw all the time that then gives
me headache. Acid/firework feeling in my head with heavy pain.
·
Stabbing pains all over me.
·
Anxiety is on another level that I never
had before.
·
Crying about 20 times a day.
·
Heart palpitations.
·
Pressure in my head like my nerves are
rubbing together.
·
Blood pooling in my legs and feet, when I
stand up my heart rate goes to 150bpm.
·
Jump out of my skin by the slightest noise.
·
Ear pain, heavy buzzing, feeling
constantly.
·
Akathisia, pacing, shaking, twitching,
cramping just pure hell and torture.
I have had no support from the medical
community and just told over and over again that it is anxiety and I need
medication. The medication never helped me and just made my life a complete
mess. I am very ill and I’m 29 years of age. I should be out there enjoying
life but I’m stuck bed ridden in pain.”
—From Petition Ref NNNNNN
__________________________
“I would like to submit my account of
attempting to withdraw from the SNRI antidepressant drug venlafaxine (Effexor).
I am a 42 year old woman. I have taken the medication exactly as prescribed and
have never abused it. I was prescribed the drug by a psychiatrist to treat
depression and anxiety after other medications had been ineffective. He
explained I would need a high dose as one of the active ingredients was only
effective then. I eventually ended up taking 375mg a day of the drug. I took it
for several years.
In 2016, it was decided I needed to
come off the drug because of side effects developing. The plan had been for me
to withdraw over a period of a few weeks. The first few reductions in dose were
difficult with brain zaps (a feeling of electric shocks in the brain) and zaps
throughout my whole body when I walked. I would also experience bizarre and
vivid dreams, nausea and night sweats. I needed to leave a lot longer than the
psychiatrist recommended between drops as those symptoms lasted for around a
month. I was told I could reduce in dose every 2 weeks. When I got to later
doses, the withdrawal symptoms become intolerable, with my mental health
deteriorating as well as the physical symptoms.
After reducing from 37.5mg to half a
37.5mg tablet my depression got out of control. I experienced uncontrollable
rage which is completely out of character for me and included me screaming and
shouting at people. The worst rage ended up with me kicking and throwing things
around and then stormed out of the house in a deeply suicidal frame of mind. I
drove past some woods and then had the idea of hanging myself and drove to the
24-hour supermarket to buy rope. Instead I sat in the car park thinking of
ramming my car into things before phoning someone.
It was after this meltdown that I
saw my GP. Her response was to increase the venlafaxine again, which would have
just made withdrawing harder in the long term. I ended up needing to take a
second antidepressant drug to help with the symptoms of withdrawal. I feel like
I am stuck on this medication now. Whenever I am late with a single dose I
experience extreme brain zaps and more worryingly twitchy eyes which makes me
worried I am going to have a seizure. Doctors do not recognize how bad
antidepressant withdrawal can be for some people and instead dismiss their
symptoms or attribute them to a return of depression. They tell patients to
withdraw too quickly when the brain and body needs time to adjust to changes in
medication after long term use. I have had to turn to the internet to find out
more about how to safely withdraw from venlafaxine and my psychiatrist has now
prescribed liquid venlafaxine and is allowing me to taper very slowly after me
showing him information I found online. It should not be up to the patient to
research their own symptoms and find their own cure. What happens to the
patients who do not have that information to hand?”
—From Petition Ref VV
__________________________
“At the age of 35, I became pregnant with
my third child and to the outside world (and to me) my life appeared
straightforward. But I had a secret: a secret that I had managed to hide since
childhood, and a secret that I shared with only one other person—it was a
secret of abuse, and the consequences of sharing this secret with anyone else
would be devastating (or so I was led to believe) and whenever I contemplated
it, sheer terror would engulf me and I would feel overwhelmed. So much so, that
I remained silent—or rather, I was silenced, and so I buried that secret deep
within me, in the hope that it would over time disappear. But it was not to be,
and I wonder sometimes, how I ever thought it would disappear.
The birth of my son in December
1996, proved to be the moment when this secret reared its ugly head and shortly
after his birth, I found myself in need of support to manage my distress.
Believing that I could trust in the expertise of professionals, I turned to
statutory mental health services for help. I was immediately prescribed an
antidepressant for my symptoms and so began a journey that was to last 17 long
and at times desperate years. By November 2013 I was sicker than when I first
encountered mental health services. I had become one of those infamous
revolving door patients, been given five different psychiatric diagnoses and
had lost all sense of personal responsibility for my own well-being. I was
dependent on doctors, nurses, locked wards, cocktails of medication
(anti-depressants, anti-psychotics and mood stabilizers) and ECT. I began to
self-harm by cutting and burning myself, I abused alcohol and smoked cannabis.
I attempted to take my own life on more than one occasion, and I’m sad and
ashamed to say that at one point I wanted to take my own children’s lives as
well as my own.
Unfortunately, throughout all those
years, I never felt safe enough nor was I able to find someone who I trusted
enough within statutory services to disclose the horrifying nature and cause of
my distress. I had lost not only those 17 years of my life, but much more;
those first precious years of my children’s lives and the final years of my
parent’s lives had passed me by without my noticing and to this day, I have
scant if any memories of my children as they grew up and of my parents as they
grew old, became ill and sadly passed away. By this time, my spirit felt
completely broken and I had simply become a label—a set of numbers from the
Diagnostic & Statistical Manual of Mental Disorders. I hated myself and the
life I was living.
I felt disempowered, dehumanized,
re-traumatized, hopeless, isolated, afraid, ashamed, guilty and angry but most
of all, desperate. I believed the time had come for me to leave the world for
good and I put together a plan—I chose the method I would use and the place
where I would spend my final moments. I did my best to write a meaningful
letter to each of my children in an effort to explain my actions. I organized
my finances so that my family would not have to worry about the cost of funeral
expenses and I wrote a will dividing up my estate.
But the warrior within me wouldn’t
allow me to carry out my plan. On the 6th November 2013, it was decided that I
should come off, overnight, the cocktail of psychiatric medications I had been
taking for 17 years, and my world was turned upside down. Whilst this rather
brutal decision was made for me and I had no choice in the matter, it proved to
be a momentous turning point in my life. I was totally unprepared for what was
to follow, as were my family and friends and the following weeks, months and
years proved to be incredibly challenging and at times agonizing. I experienced
unimaginable emotional upheaval, anxiety and insomnia so debilitating I was at
times unable to function, I cried when I didn’t want to cry, I laughed when I
didn’t want to laugh and I felt intensely angry when I didn’t want to feel
angry. I experienced moments of utter despair, moments of sheer elation and
moments of paranoia. It felt like my brain was constantly working on overdrive
and I found it incredibly hard to sit still, I felt compelled to be doing
‘something’ all the time.
Whilst some of these experiences
have improved, I am still experiencing difficulties with sleep, agitation and
anxiety. I cannot compare the experience to anything else I have ever lived
through. However, challenging the process has been and still is, I don’t regret
being taken off all medication—to remain medication free has been one of the
best decisions I have ever made in my life, because now, despite all these
withdrawal symptoms, I am “living” and not just “existing”. Now when I walk
down the street, I look up at the sky and I notice the world around me. My
curiosity, passion and zest for life are evolving day by day and I can
sometimes look in the mirror and smile back at my reflection. Now I am emerging
as a person capable of feeling, facing and coping with every human emotion it
is possible to experience, and that feels so good. I now have hope instead of utter
hopelessness. Now I feel empowered and have choice and control back in my life.
Now I am finally beginning to find a true sense of self and purpose. And four
years later, I continue to remain drug free. I haven’t seen a psychiatrist or
been in contact with statutory mental health services for over 2 and a half
years. I am living independently in the community surrounded by my family and
friends and coping with everyday life.”
—From Petition Ref GGG
__________________________
“My citalopram nightmare: At the age of 28,
one month after my birthday, my life would change as I knew it. I went to my GP
after my honeymoon in 2014 and decided to come off citalopram. I was no longer
experiencing anxiety and was desperate to lose weight and eventually start a family.
My GP’s advice was to come off the drug over two weeks. I did as my GP
instructed, reducing the dose in half and alternating daily. I experienced some
mild head zaps and some morning anxiety I was unfamiliar with; however, this
soon disappeared.
Fast forward 18 months off
citalopram, I experienced some anxiety and stress having moved home, town and
needed to find a job. The stress of applying for jobs, attending several job
interviews, and financial worries bothered me, so I went back to my GP. Within a
few minutes I walked out with a prescription for citalopram in my hand, the
standard 20mg therapeutic dose, believing this would help the stress I was
experiencing. What happened next is unimaginable to most people, and for my
family and me, truly heart breaking. After a couple of days back on citalopram
I was delusional and psychotic. I thought I had murdered my husband and dog
with a kitchen knife. I believed I was a danger to everyone, and had nonstop
intrusive harming thoughts, no sleep, no appetite, pains, severe agitation, and
an episode of hypomania (elated, thinking I had cured anxiety). This went on
for about eight weeks. During those weeks I was informed by GPs and staff at
the local hospital to stay on citalopram and would soon find myself on a cocktail
of citalopram, lorazepam, diazepam and quetiapine.
I was deteriorating, losing my mind
as my brain was being chemically tortured by these drugs, my poor body unable
to metabolize them. I knew these drugs would kill me if I didn’t get off.
Symptoms of drug toxicity had already began when my GP performed blood tests
whilst on citalopram. Blood and urine tests revealed I had very low potassium
levels in my kidneys (requiring 2 ECG’s), raised blood counts, and protein and
ketones in my urine.
I came off all drugs on 1st August
2016. I desperately hoped I would be back to my old self and the six-week hell
of an ordeal would be over. Only that didn’t happen. It’s January 2018 as I
write this email to you. I haven’t felt a positive emotion since the reaction.
I battle suicidal thoughts daily, purely because I can no longer identify with
who I used to be. I am a shell of who I was. I suffer with chronic fatigue,
severe apathy, serious episodes of depression, depersonalization/derealization,
unable to sense time or atmosphere, racing thoughts, poor memory loss, unable
to form new memories, confusion, vivid dreams and nightmares, blurred vision,
visual snow, and tinnitus. There isn’t a moment when I am symptom-free. My life
is now in ruins. I want to assure you I never experienced any of these symptoms
prior to this citalopram and would never have considered myself mentally
unwell. I had never seen a psychiatrist. I had a normal life as a wife, worked
full time in financial services, enjoyed hobbies such as swimming and cooking,
could drive and enjoyed holidays. I now have to live off disability benefits
and live in council housing because I am unable to work, and my marriage fell
apart last year.
What I would like most from this is
for the medical community to stop informing patients these pills are safe and
effective. Inform patient’s why suicide is a side effect and what can happen if
you are unable to metabolize these drugs. Health care professionals to be more
aware of the symptoms of serotonin syndrome, withdrawal and neuroleptic
malignant syndrome. Monitor patients closely beginning antidepressants. Work
together in the medical community to produce safe tapering plans for patients
wishing to discontinue antidepressants. Please take our accounts seriously. I assure
you if this happened to you or someone you know you would do everything in your
power to see these drugs only prescribed in desperate measures and would want
to prevent this happening to anyone else. How many more lives are going to be
taken and damaged needlessly?”
—From Petition Ref QQQQ
__________________________
“I was physically injured from Lexapro
(escitalopram) and Xanax (alprazolam). I am disabled in ways that are still
hard for me to even grasp. These medications destroy much -needed receptors in
our brain. Without them we are unable to function on a human level. The things
I have experienced are pure torture and there is no help. People are committing
suicide just to make the pure terror and pain stop. It’s inhumane what happens
to us. And the doctors do not even recognize that this can and does happen. We
are left alone to try to survive this. It has been described as human torture
chamber.
I am 10 months out from taking these
medications (poisons). I was a happy and very productive women. It was given to
me for a thyroid condition. And has destroyed my life and my brain. I have
central nervous system damage. Pain like no one should have to live with and
akathisia, cortisol rushes, agoraphobia (never was afraid of anything!). I have
not been able to leave my home since. I have lost everything!!! I even lost my
ability to speak or walk when this first hit. It’s a horrific injury caused by
these dangerous drugs. I never abused anything. Took as prescribed!!!! There
are people taking their lives because of this. Not because they are crazy. But
because the torture is unbearable. I don’t know if I am going to survive.
Please help us.”
—From Petition Ref FFFFFFFF
__________________________
“‘What symptoms did you experience?’ I am
on day seven of my second attempt at a reduction and missed the deadline again,
because of the wall climbing feeling of wanting to get out of my body. I can’t
sleep as every time I close my eyes the spinning vertigo feeling exacerbates my
nausea... then every inch of my body feeling weighed down by something makes my
breathing labored, a lack of oxygen making me feel panicky and shortens my
breathing to the point I feel anxious and hyperventilate... this is not fun. To
have all of this on top of my issues?
‘Were you warned about the
withdrawal symptoms?’ No one told me it would be like this. I was told I would
be weaned off. No one told me that a doctor’s advice (reducing my venlafaxine
from 300mg to 225mg) would find me laying in the street (2016 my first attempt
at coming off venlafaxine). I had strangers call a paramedic who then
threatened to slap me as she stated I was not having a panic attack, but I was
having a tantrum!
‘Were you believed by doctors when
you told them about the side effects?’ No, no, and definitely NO. Only one
doctor took on board what I said, unfortunately I have since moved and no
longer have her support. A paramedic empathized completely as she herself went
through the experience!
‘How has your life changed since
taking psychiatric medication?’ Downhill, don’t work, bored, and unable to do
anything productive. I’m very debilitated by this antidepressant. This is such
a good opportunity to share with people: professional people, the government,
about the horrors of taking psychiatric medication. So we don’t want to miss
this opportunity to share as many horror stories about psychiatric drugs as
possible, as so many doctors don’t believe us!”
—From Petition Ref DDDD
__________________________
“In 2016, after 15 years of having
medically undiagnosed symptoms which left me chronically fatigued, often dizzy
and just generally feeling ill often, I was finally diagnosed with a disorder
of the nervous system called Postural Tachycardia Syndrome (PoTS). For 7 years,
the only treatment I was given was an antidepressant to up my energy levels and
probably to treat what doctors thought was actually anxiety because of my dizzy
spells. Although I was never diagnosed with depression, my GP at the time told
me antidepressants often help with energy levels and dizzy spells and weakness.
Whilst being referred to a
cardiologist to rule out POTS, my GP told me ‘that dose of antidepressants is
so low you may as well not take it or up it’ so when I got my POTs diagnosis, I
tapered my dose for a week or so and then stopped taking it. Although I have
always been highly sensitive, the only thing which had made me feel genuinely
low for long periods was dealing with my hellish fatigue and symptoms and being
told I was ‘FINE’.
I don’t berate that GP as she was
the only one who sent me for any further testing in 15 years, but I believe she
was just following the current guidelines for withdrawal which are not helpful
for most people. After around a month off the meds although I was on a high
from my wedding, I soon started to feel a little odd. I was having strange
dreams and crying in restaurants over small things, I also was seeing very odd
scary images in my head.
And then I lost a beloved member of
my family, and was crying daily, feeling like a dark cloud was following me. I
just did NOT feel OK and I did NOT feel like myself anymore. My GP said it was
nothing to do with withdrawal; that it was just grief. Yet I could see images
of the holocaust in my head and just felt like I was in a constant state of
fear. I had NEVER experienced anything similar in my life.
I still to this day do not know 100%
if I was having a withdrawal or grieving badly, but from talking to other
people, I believe a lot of what I experienced were withdrawal symptoms. It was
VERY hard not to go back on the tablets and I am deeply sorry that I had to
feel like that during the first 6 months of my marriage. I only wish my GP had
told me to slowly wean off my medication so as not to suffer as I did. As a
trainee psychotherapist who has had 4 years of long term therapy with two
different therapists, I am sure this was out of character for me and that a lot
of my symptoms were due to withdrawing from citalopram.”
—From Petition Ref VVVVVV
__________________________
“Eighteen years ago, my 12 year old son was
prescribed Prozac (fluoxetine) for depression. Not long afterwards, he was
found dead in the orchard next to our home. His death was initially determined
to be a suicide, but later when an attorney examined his autopsy report, he
called for the investigation to be re-opened as a possible homicide. My son had
been with a friend on the day of his death, and his friend had also been
prescribed an antidepressant. Three experts provided statements indicating that
homicide should not have been ruled out, and that the initial investigation had
been poorly done.
I am convinced that my son’s death
was the result of dangerous drugs prescribed to two adolescent boys whose
parents were never provided with enough information to make a truly informed
decision about whether the drugs were safe or not. I testified before the FDA
in Feb 2004, demanding that SSRIs be removed from the market, or at the very
least have the strongest of warnings be placed on all SSRI drugs. The warnings
finally came through later that year, but they came too late for my son.
These SSRI drugs are not safe for
everyone. There is ample research that indicates a small percentage of people
cannot properly metabolize some of these drugs, but when you consider that
millions of people are taking these drugs, that ‘small percentage’ translates
into tens of thousands of people who are likely to experience adverse effects
that far outweigh any benefit they might receive. It’s time to stop supporting
drug companies who lie and hide crucial evidence and to protect the citizens of
your nation against harmful drugs!”
—From Petition Ref NNNNNNNN
__________________________
“I suffered a very bad reaction to
antidepressants that made me so ill that I lost 15 months from work. I took an
SSRI antidepressant for the first time in my life aged 40 after I was
experiencing some mild anxiety for a few weeks. I went to see my GP who gave me
sertraline. I took it that morning and by 5PM I had started to vomit and had
the first panic attack that I had ever experienced in my life. By evening I had
started to feel not only depressed but started to have strange thoughts about
committing suicide by hanging myself. I did not realize that these medications
could cause all this and thought I had suddenly gone mentally ill in a few
hours.
I went back and saw another GP,
crying, very distressed as the sertraline had given me insomnia, too. The GP
gave me a new antidepressant to try (fluoxetine) and diazepam to help me sleep.
Within a few days I had become much worse. I could not sit still, sleep,
vomiting constantly. I began to hear voices and asked my husband to take me to
hospital as I felt extremely suicidal. I went to hospital, where I was told it
was lack of sleep causing my symptoms and was to continue with the fluoxetine
and diazepam and was given some zopiclone sleeping pills and the crisis team
began making home visits.
After another week, I continued to
get worse and the crisis team doctor agreed with me that I was having a rare
reaction to SSRI antidepressants after I refused to take it anymore. I was put
on a new sleeping pill called trazodone to help me sleep. I did not realize
that this was also an antidepressant. This was in March 2016. My GP increased
the dosage without asking me. I could not tolerate the higher dosage so tried
to come off the antidepressant and ended up in A&E again with electric
sensations. Crisis teams were called again and the doctor thought the dosage
changes had increased my anxiety, so he lowered the dosage and added another
pill (pregabalin) for my anxiety on top of the trazodone and diazepam.
I became so ill my GP sent me to a
mental health center (secondary mental health services). They added another
antidepressant (duloxetine) to all the medications that I was taking. By this
time, the crisis team had a CPN nurse visiting me also. A few days into taking
these medications I was seen by the crisis team who wanted me to go into
hospital as they thought I had the strangest case of post-natal psychosis they
had ever seen as it does not usually come and go.
I now know that I am sensitive to
not only taking these medications but also to starting and stopping them and
dosage changes. I was in hospital for six weeks. I felt even worse when I got
out but had got used to feeling suicidal. My doctor kept me on the trazodone
after I refused to carry on with the other medications apart from diazepam. He
added another pill called buspar. I began to get problems with my neck and face
muscles and in February 2017 was pulled off the medication cold turkey. Ten
months later, I’m able to work again but still have a problem with my neck
muscles and electric sensations. These medications caused me to lose two years
of my life but am hoping to fully recover. I have now been signed off from
mental health services.”
—From Petition Ref RR
__________________________
“I believe I have been damaged by
psychiatric drugs. All told, I spent over 30 years on a variety of different
antidepressants such as Anafranil, Seroxat and Effexor. In 1979, my marriage
was failing and I was seven months pregnant. During this distressing period in
my life, I was referred to psychiatry.
It was at the suggestion of my
psychiatrist that I started on Anafranil, one of the older tricyclic
antidepressants, after assurances it was safe in the last trimester of pregnancy.
As it turned out this was not the case as my baby had convulsions at 8 hours
after birth, directly attributed to withdrawal from maternal Anafranil. My
psychiatrist was unaware this could be a problem. Many studies now seem to
suggest that there is an increased risk of autism spectrum disorders in taking
antidepressants in pregnancy.
In hindsight, I wish I had never
taken an antidepressant. It should have occurred to me to come off them but I
had been diagnosed as having a depressive illness and I thought I needed drug
treatment. This, I feel disempowers the patient from seeking non-medicated
routes to solving their problems. Paradoxically as the years progressed
antidepressants did not appear to improve my health. Most days it was a
struggle to get out of bed. It was becoming clear to me that antidepressants
were causing me considerable problems. Any time I failed to get my prescription
I felt panicked and jittery. The side effects were debilitating and wide
ranging. I was plagued by blurred vision, heavy sweating, fatigue, irregular
heartbeats, weight gain, photosensitivity, hives, gastrointestinal problems,
deficiencies in memory and concentration and a general feeling of apathy. I had
no motivation beyond taking my pills and dragging myself through the day. There
were times when I ended up in hospital after failed attempts to come off
antidepressants without appreciating I was actually in withdrawal—something
none of my doctors ever picked up on.
I would have liked the help of my GP
to taper off my antidepressant but I knew he preferred I take them
indefinitely. I hadn’t anticipated having any problems coming off Effexor if I
kept to a reasonable taper plan, though in retrospect I wish I had prolonged
the taper for far longer. I thought I might have some difficulties for a few
weeks, perhaps a couple of months at most, as I’d once been told, but the idea
that withdrawal might last years seemed inconceivable. Initiating a taper in
2010 was my chance to regain my health after many years of feeling chronically
unwell, but had I been aware that I risked suicide and years of protracted
withdrawal symptoms I might have thought twice. Nothing in the medical
literature ever prepares you for the brutal experience many of us face coming
off psychiatric drugs, antidepressants included.
Within a week of being off Effexor,
I had terrible panic and inner turmoil on a scale I had never encountered
before. I was crippled by this constant torture that I rarely left my sofa
beyond going to the bathroom. I lived minute to minute. I barely slept or ate.
This was a nightmare that had no end. I tried desperately to reinstate
antidepressants but with no success as they made me feel much worse. During
this time, I had a psychiatrist tell me I needed antidepressants like a diabetic
needs insulin. In the summer of 2012 I attempted suicide.
Without the help of my family I
would not be here today. After a short spell in a psychiatric hospital, I was
discharged with a prescription for yet another antidepressant alongside Valium
and a sleeping tablet. I had failed to convince my doctors that I was suffering
from protracted withdrawal; instead my symptoms were seen as evidence of
relapse. Life was unbearable and I was prepared to try all sorts of treatments
that in other circumstances I would never have considered like Seroquel (an
antipsychotic), Pregabalin (a mood stabilizer) and benzodiazepines. Thankfully,
I had the resolve to say no to lithium and ECT.
Because doctors/psychiatrists are
largely uneducated about antidepressant and benzodiazepine withdrawal, patients
run the risk of further unnecessary and damaging psychiatric drug treatments.
Polypharmacy increases the likelihood that patients remain stuck on these
medications for life with implications for their health.”
—From Petition Ref C
__________________________
“I am writing in support of this petition
as this is the supposedly civilized thing to do in a civilized, democratic,
accountable society. But let me tell you there is no civility or accountability
in the gross harms many have suffered because of psychiatric drugs. Also, what
good are elected representatives if the issue is never addressed but is
repeatedly brushed under the carpet?
These drugs have wrecked my life,
both on them and after withdrawal. What is worse I should never have been on
them in the first place as my problems could and would have been resolved
eventually. What sort of treatment thinks that prescribing dangerous drugs
hardly tested and with unknown effects is going to help anyone? Without wishing
to sound like a conspiracy theorist sometimes it seems that mass drugging of
the populace is a desired outcome as the same thing happens again and again.
Antidepressants, benzodiazepines, amphetamines, barbiturates, opiates, cocaine
the list goes on. For over ten years now I have suffered from the most
horrendous symptoms every second of every day with no relief at all. I have
been left unemployable, I had to give up studying as a part time mature
student, lost relationships and have had any semblance of normality obliterated.
I am lucky in that I have a good GP
who is prepared to listen and who has been receptive to literature on this
subject, but it still is no real help as nothing has helped at all with these
symptoms. I still suffer from screaming tinnitus, insomnia, pins and needles
all over, burning down my spine, pelvis and down my legs into feet, akathisia,
intense anxiety, panic, drug sensitivity, chemical sensitivity i.e. paint
fumes, gastrointestinal issues, bladder issues, apathy, weakness, jelly legs, faintness,
tingling, suicidal thoughts alien to myself and more. This is torture and every
day is a struggle to survive.
Prior to these drugs I was a healthy
28 year old man but now, twenty years later, I have been robbed of everything.
And for what? Certainly not any supposed benefit. Whilst taking them I was a
different person, irritable, angry, aggressive, paranoid, violent, uncaring,
insensitive and I nearly lost my family, friends and my life. Now people can
see the real me again and they are in agreement that those drugs were the cause
of my personality change. I began drinking and smoking heavily and taking drugs
although I never touched street opiates as I had still some sense to know the
outcome of that addiction, but ironically opiate withdrawal is over in a matter
of weeks whereas psychiatric drug withdrawal has lasted over ten years.
Due to my behavior, I was arrested
four times and spent time in prison and I have this stain on my character for
life. Much more happened whilst under the influence, yes I use that term the
same way as alcohol as that is what these drugs are, not medicines but mind
altering drugs. I am so angry about what has happened to me and countless
others and any right and just person should be equally outraged. This is a
scandal on a grand scale and one that needs to be brought into the cold light
of day. How much is it costing the public purse, my estimation countless
millions as I have estimated just myself running into hundreds of thousands of
pounds when you add everything up. Drug costs, doctor visits, specialists,
hospitals, prison, probation and social security benefits as an example. How is
this allowed to happen? It needs to addressed and addressed now.”
—From Petition Ref XXXXX
__________________________
“There are far more problems with these
prescribed psychotropic medications, such as antidepressants and
benzodiazepines, than without them. There is nothing really wrong with the
human condition, being sad, angry, traumatized by life events. It’s our body’s
natural response to life’s difficulties. But our bodies are equipped to
recover, given time, patience, understanding, acceptance, practical help, as
well as nudges from non-pharmaceutical interventions such as exercise,
relaxation techniques, acupuncture, meditation, mindfulness, talking therapies,
being in nature, etc. There’s an endless list of non-pharmaceutical
possibilities. My life was deformed by prolonged use of antidepressants and
benzodiazepines. Not once did any medic suggest I might be better off without
them. I was convinced by this ‘therapy’ I was an inherently bad person, and I
would always need their poison to ‘cure’ me. The longer I stayed on them, even
though it was a ‘low dose’, the more paradoxical the effects of them became.
Well, I’m not inherently bad, I’m
just a normal human being, so please don’t anyone at all rewrite my reality.
I’m left with a very poor memory and cognitive impairment, balance issues,
musculoskeletal problems, muscle wastage, and many other withdrawal symptoms.
When I reflect on how much I suffered through out my life from both side
effects of taking the poison, and now with protracted withdrawal symptoms, I
can only grieve for future generations who will likewise suffer if this
pharmaceutical propaganda is allowed to continue.”
—From Petition Ref FFFFFFF
__________________________
“I am submitting an anonymous submission
for the purposes of bringing to light serious emotional/psychiatric harm
sustained by taking antidepressants, and the side effects that remained even
after discontinuation. I’m a 30 year old female and I’ve had PSSD (Post-SSRI
Sexual Dysfunction) since 2009. I have a history of severe OCD and began taking
brand Zoloft when I was 16 to treat my symptoms. I had no sexual side effects
at all but ended up tapering off the medicine when I was 20 because I could no
longer afford to pay for the medication. After I discontinued, the OCD thoughts
came back, and three months later I was on meds again—only now I was taking the
generic sertraline, at the same dose, because that was all I could afford
without insurance.
I became asexual literally
overnight. I lost all genital function, had no ability to reach orgasm, no
sexual attraction or fantasies whatsoever—it was like a switch had been turned
off. The prescribing psychiatrist told me this was normal, though, and to stick
with the drugs, which I did for a few more months, until finally I got fed up
and ‘cold turkeyed’ off the medication. Even though there were no longer any
drugs in my system, every single side effect remained. For the last nine years,
I have tried almost everything I can think of to get my sex drive back. With a
few, temporary exceptions, nothing has succeeded in giving it back to me. I
have taken all kinds of herbs/pills and done all kinds of exercises. I even took
Bupropion XL, which delivered very inconsistent results and unfortunately gave
me a seizure. Nothing has truly helped.
Right now I am involved with a
community of similar PSSD sufferers called the PSSD Forum trying to find
answers and hope. ‘Did your doctor warn you about the withdrawal effects?’ My
psychiatrist did not warn me about any side effects. After starting the
medication, when I brought up the fact that I did experience side effects, he
said that it was “normal” and to continue the medication. When I abruptly
discontinued the medicine, the side effects remained. No one was concerned
about it except for me. Subsequent doctors and psychiatrists I
visited—including a gynecologist—told me that it was normal for a woman to have
a low sex drive, and that I shouldn’t worry about it.
‘Have pharmaceutical drugs harmed
you?’ The loss of sex drive has been devastating to me. I no longer feel
desire, arousal, experience lubrication, or have orgasms. My genitals feel
‘dead.’ I still have OCD, but without taking the medication that harmed me, I
have no way of treating it. ‘Have you had to give up work?’ I have not given up
work. However, the self-loathing and lack of confidence I felt after my fallout
with the medication was life-altering. I no longer felt like a woman or someone
that anyone could love. As a result, I ‘aimed low’ in life, turning down
opportunities to better myself and be happy. I avoided social situations out of
shame. I also allowed friends and family to treat me badly, telling myself I deserved
no better because I wasn’t really human anymore.
My doctors told me that it was
depression and OCD that made me feel this way, not loss of sex drive. I was
frequently told ‘there’s more to life than sex’ and to not worry about it, even
though I was in a loving relationship with someone else, someone with a
disparate (healthy) sex drive to mine, and we used to have fulfilling,
uncomplicated sex on a regular basis. Nine years of PSSD have done much to tear
my life and mental health apart. Thank you for allowing me to tell my story. I
hope it helps others.”
—From Petition Ref HHHHH
__________________________
“In March 2015 I went to my company doctor
with work stress. I did not meet the ICD-10 criteria for depression at all. I
had no problems getting out of bed, was not suicidal had no increase or
decrease in appetite. I was just stressed and not sleeping enough due to long
hours at full time work and in my part time studies. My doctor, in a 5-minute
consultation and without explaining anything, handed me a prescription for
venlafaxine. Venlafaxine is a third choice antidepressant that is normally
prescribed for treatment resistant depression. It was the first antidepressant
I ever took. The pharmacy filled the prescription of 10 pills without
explanation and without handing out the patient information leaflet.
I took this medication for five days
and got several dangerous side effects, one of them severe bleeding; aside from
that agitation, insomnia, paranoia and more. After five days of horrendous side
effects, I stopped the medication according to the doctor’s instructions. Aside
from feeling hungover, I was completely fine for a day. Until after about 36
hours the withdrawal symptoms set in. I suffered convulsions, myoclonus, urges
to commit suicide, rapid mood swings, aggression, crying, sweating so much that
we had to change the bedsheets 5 times per night, involuntary movements,
tremors, passing out, vertigo, dizziness, arrhythmia, chest pain, vomiting,
severe suicidal depression, paranoia, anxiety, electric shocks in the brain,
disorientation, cognitive problems, memory loss, concentration problems. The
list goes on and on. I had over 70 different, disabling symptoms.
I got no help from my doctors. Due
to the extreme involuntary movements, my neurologists diagnosed me with a
‘functional movement disorder,’ migraines, and chronic fatigue syndrome. I had
none of these issues before taking and stopping the venlafaxine. I was off work
for 2.5 years due to these symptoms.
To this day, I still suffer severe
symptoms. I had to return to work because I cannot afford to have no income.
Disability payments were denied because a ‘Functional Movement Disorder’ is, in
the views of the neurologists, not enough grounds to be off work. They ignored
the other symptoms I have and generally disbelieved me. I am at work now,
trying to survive every day without getting fired. I have to leave meetings
often because I get seizure-like episodes. I forget simple instructions and
have to sleep often during the workday. The drugs have completely eradicated
the ability to feel any positive emotion. They have practically made me
inhuman, only able to feel negative emotions or numbness. I feel disconnected
from the few friends I have left after being ‘mysteriously’ sick for years.
Before, I was always an overperformer at work. I had many friends. I was a
person other people enjoyed to be around. Now I’m a shell of my former self,
constantly in agony, electric shocks shaking my brain every couple of minutes,
feeling numb and disconnected. I feel let down by the medical profession who
poisoned me, denied the harm they caused and refused to give me any help or
support.”
—From Petition Ref GG
__________________________
“At 41 years old, I entered perimenopause
with a resounding thud. The cluster of symptoms I presented with to numerous
medical professionals, all pointed perfectly to menopause.
Despite a family history of early
menopause, and all the symptoms that suggested menopause, I was refused hormone
treatment due to being too young to be going through menopause. And so my
journey to beyond the depths of hell commenced. I do feel it necessary to point
out that prior to the drugging that would ensue, I was an extremely highly
functioning member of society.
I never suffered from anxiety or depression,
I had a near perfect life and I woke up every day reminding myself how lucky I
was to be blessed with such a wonderful life. But that was suddenly about to
change when benzodiazepines were introduced to combat menopausal insomnia. From
the very first benzodiazepine pill 3.5 years ago, I have lived in a tortured
and altered state of reality. I took benzos for approximately four months
during which time I was in and out of the doctor’s office, pathology, emergency
department and specialist offices. My mental and physical health declined
rapidly. I could not function and was bedridden, my family holding a bedside
vigil as I prepared to say goodbye to my family. My family and I had no
conclusion to reach other than an obscure undiagnosable disease that would
ultimately led to my death. Having no answers and deteriorating rapidly, I was
then cold turkeyed off the equivalent of 20mg of Valium and put on the
antidepressant Effexor. I took this drug for two weeks, during which time I
openly started talking about suicide to the husband whom I loved and adored,
the father to my young children whom I loved and adored.
Shortly after my introduction to
Effexor I hospitalized myself and was diagnosed with major depression. Never at
any point did any medical professional suggest it could have been the drugs
despite there being mounting undeniable evidence that should point in that
direction. The horrific symptoms that I encountered during this time (some
still to this day even at 16 months off the drugs) are too numerous to list,
but here I provide a small sample for your reference: suicidal depression,
akathisia, extreme anxiety, brain zaps, amnesia, lack of any human emotion
aside from extreme fear, intrusive thoughts a human brain would not normally
produce, inability to differentiate hot from cold on my skin, visual
disturbances, paranoia, hallucinations, olfactory hallucinations, hearing loss,
nausea, optical migraines, severe vertigo, tinnitus, myoclonic jerks, extreme
nerve pain, inability to cry, feeling detached from reality.
These symptoms are unforgiving and
beyond cruel. What is even more distressing than these symptoms is the fact
that every second person I speak to is on these drugs, or has been at some
point. Often they have been put on them for depression when all they wanted was
counselling. They did not believe they even had depression. They continue to
take them not because they are ill but because the withdrawal symptoms are life
threatening both physically and mentally. None of these people have been warned
of the addictive nature of these drugs and the horrific withdrawal symptoms
which can last years, and nor was I. How can the medical establishment and
governments continue to ignore the damage these drugs are causing? Suicide
rates are increasing, depression is increasing and so is the prescribing of
these drugs. If the drugs worked rates would be decreasing. How can this simple
fact be ignored? Prescribing of these drugs must stop.
Withdrawal centers for psychotropic
drugs must be established along with support services. Please take notice of
these submissions, and act accordingly. This is an epidemic which is
responsible for the deaths of a number of innocent victims. The family members
of people who have committed suicide on these drugs, and due to horrific
withdrawal they cause, need to know the truth about why their family member
died. The world needs to know the truth.”
—From Petition Ref MMMMMM
__________________________
“I am a mother of three. As of today, I am
seven months and eight days clean off my antidepressant venlafaxine (Effexor),
which is in the SNRI group. I am still very much suffering from after effects
and in recovery after long-term use. Which means today I am not able to tell my
story to the best of my ability so I will give you the bones as best I can. The
main reason I want my story heard is that after I was manipulated and coerced
into taking this drug, I was told it was not addictive. I was essentially just
left on the medication for years; this stretched eight and a half years. They
did not make me better.
The beginning is probably a common
story. I had a difficult time at home and at the age of 18. I was diagnosed
with clinical depression. After I left home I was signed off work and given
various medication. But there seemed to be a lack of education around it; I was
not offered any counselling or even any information regarding the medication
itself. I was left with a packet of drugs with no warnings or support. I will
admit to not taking to them properly; I took one or two and they made me sick
so I went back and said they didn’t work so was sent away with different ones.
But in my mind, I thought they worked like a painkiller; that they should work
instantly, and they didn’t.
When I was 20, I had my first
daughter and things changed. I thought I’d turned a corner and I look back at
that young woman and feel utter sadness and regret and dearly wished there was
proper support and understanding for young people dealing with issues. Like
most young woman with troubled backgrounds, I suffered with post-natal
depression. By the time my daughter was 10 months old I had lost too much
weight. The doctors told me I had to stop breastfeeding and if lost any more
weight I was going to be sectioned.
This is where the story gets
difficult. I had a very clear ultimatum. I had no family around me and a
partner who had no clue how to do anything let alone look after a child. I was
seen by the mental health team who were urging me to put things in place so if
I was sectioned, I would need to have someone to legally care for my daughter.
The pressure was on me to put on weight and one of the nurses persuaded me to
try the venlafaxine the doctors were trying to prescribe. I felt manipulated as
I wanted to find and alternative but with no other option I took them. There I
believe my fate was sealed.
The following year I fell pregnant
again, this time with my partner ending the relationship if I went ahead with
the pregnancy. I couldn’t not have the baby so then not only did my
relationship breakdown, the doctor told me I had to discontinue the medication.
Of course I knew this but I was extremely vulnerable! The doctor told me he
would give me a week half a dose and that was it. I said to him, ‘Could we
please not do it too quickly?’ He looked at me unsympathetically and sniggered,
‘You aren’t on crack.’ Of course, I won’t be the only person that says that
this drug is addictive.
I went through hell, but I did have
a baby and a baby on the way to suffer through. I was suicidal and agitated
which I was never before. I was repeatedly told it was not the medication. My
home life did improve after this; I settled down with another partner and
although still vulnerable to past issues I was able to function, get a job and
my weight was stable. I then had my youngest daughter who was born just as my
middle daughter turned two. I breastfed her for over a year and was quite
happy. However when I stopped breastfeeding, the cracks began to show: I felt
low, tired and tearful. I went to the doctor, a different doctor but another
one who looked at just one solution. I was put back on the medication.
What follows is a train crash and
the end of life as I knew it. The medication made me detached and unable to
focus on normal day to day activities. Four months later, we moved home and my
daughter was admitted to hospital with meningitis, and although I was able to
focus on getting through the initial crisis. I had a complete breakdown. I
became increasingly suicidal, anxious and agitated. My dosage on my
antidepressant was doubled and I was given valium and sleeping tablets. This
concoction of drugs given to me seems baffling to me now as I was openly saying
I was suicidal but it was followed was a cycle of uppers, downers, increased
agitation and psychosis. I became manic and reckless; I felt more and more
detached from reality. The medication was open to abuse and I started to abuse
alcohol to calm down or quiet my mind.
For nearly three years I had a range
of professionals walking in and out telling me I was ill and I was not doing
enough to put it right, I needed to work with everyone. Great things to say to
someone who is agitated and suicidal. I was however repeatedly asking for help.
At one point I was at the doctors at the very least once a fortnight but
sometimes on a weekly basis asking for help. At no point did anyone address the
issue of medication or even query it. After a particular bad episode I tried to
come off the tablets. I was put on a lower dose. I stopped any other
medication.
Things within my home life began to
settle so I started to stabilize around it. I don’t believe I mended; I just
started to function better around it. I became less agitated and reckless but I
became more detached. In this sense, professionals slowly stopped having
concerns, I stopped asking for help, things seemed to get better on the
surface. But the issues didn’t go away; the tablets still affected my thought
process. My memory is patchy and they made me aggressive and volatile. I became
a machine and worked nonstop. I feel like years have just fallen out of my
head. For the last seven years I’ve had no break, no way of listening to the
needs of my body or life. I stopped feeling anything; I didn’t know when I was
too tired or too hungry.
After a particular stressful end to
2015, I felt I had to address my life and most aspects. When I was able to
reduce my workload, I weaned off the venlafaxine, still believing that they
wouldn’t be addictive. The withdrawals were utter hell but the shock was
genuinely believing that physical effects were all I needed to worry about.
No—the utter horror is now months later I am suffering with days of severe
agitation sleepless night and debilitating headaches amongst other things. I
believe that we all have the right to find out why we were persuaded to take
these drugs and why we were left on them for so long. I feel I was manipulated
into taking them and then told they weren’t addictive and then repeatedly
criticized for my thoughts and feelings on the medication. I feel I was let
down and could very easily been a suicide statistic and forgotten about. I am
not and I will be vocal. But I feel my children were let down repeatedly and
were robbed of their mother. I trusted a system that clearly didn’t know what
it was doing and I deserve to find our whether I have been left with permanent
damage.”
—From Petition Ref Y
__________________________
“I was prescribed citalopram (an SSRI) for
‘mild depression’ in 2013, after I messed up my first year in university. Who
wouldn’t be in a bit of a downer after that? Regardless of context, I was
labelled with ‘depression’ when I was compared against a questionnaire
conducted by the GP I often question after this assessment and the label
attached to me of ‘mental illness’; at what point is it not normal or not simply
being human to express emotion at negative life experiences? Is happiness the
only acceptable emotion we should hold in ourselves, regardless of
circumstances? If I had arrived there and told them my close family relative
had died and I was feeling down about it for quite some time, I can guarantee
I’d be told I had a mental illness.
This prescription given to me, it
was the first port of call, and no counselling was offered. I had several minor
reactions to starting the drug—most prominent of those was being unable to get
to sleep for two weeks. I used to walk the streets of my town in the middle of
the night just so I had something to do and to reduce my frustration. Other
side effects included a stiff neck, stiff jaw, teeth chattering and inner shaking.
I was reassured by my GP that these side effects would take six weeks to settle
and it wouldn’t be until then that I would see the full benefits of the drug.
I remained on citalopram for two
years. Within a month of being initially prescribed the drug, a doubling of the
dose was made by the GP and I remained on that dose, until one day I
questioned, “Why the hell am I taking this?” It served no purpose. I had no
follow up or monitoring from my GP who prescribed it. It was as if they
prescribed it to me indefinitely. I merely felt a former shell of myself;
emotionally numb for 2 years, with no highs and no lows. What sort of life is
that? Unable to feel human emotion—a chemical lobotomy.”
From Petition Ref DDDDD
__________________________
“In 2009, my son, who had never been
depressed in his life, went to see a doctor over insomnia caused by temporary
work-related stress. He was prescribed the SSRI citalopram, and within days he
had taken his life. At my son’s inquest, the coroner rejected a suicide verdict,
but delivered a narrative verdict, citing citalopram by name as the ‘possible
cause.’ After the inquest, I noticed that what happened to my son was far from
unique. Eventually, in 2013, I began the ‘AntiDepAware’ website. This includes
links to reports of inquests held in England and Wales since 2003, most of
which have been discovered in the online archives of local and national
newspapers. It must be noted that this list is far from exhaustive, but even
so, contains over 5,500 reports on self-inflicted deaths, all of which are
related to use of antidepressants. As my research continued, certain trends
became more noticeable, so that I was able to conclude that the link between
antidepressants and suicide is heightened: 1) In the early weeks of uptake or
if the dosage is increased, decreased, withdrawn, or changed for another brand
(This is highlighted in the British National Formulary) 2) When SSRI
antidepressants have been prescribed alongside other psychiatric medication,
such as anti-psychotics or benzodiazepines 3) When the deceased has been
prescribed antidepressants not for clinical depression, but for what NICE terms
“sub-threshold” conditions such as anxiety, PTSD, work-based stress or grief.
Much of my research has been
directed towards children who have taken their lives after being prescribed
antidepressants. Because of the acknowledged risk of suicidal ideation, NICE
Clinical Guideline 28 lays out three criteria, all of which must be met if
antidepressants are to be prescribed to children under 18. These can be
summarized as: 1) Only if the antidepressant prescribed is fluoxetine; 2) Only
if the child has been diagnosed with moderate to severe clinical depression; 3)
Only if it can be shown that the prescription has been preceded by at least 3 months
of “specific interpersonal therapy” which has proved ineffective. In other
words, NICE regards the prescription of antidepressants to children as an
absolute “last resort” option. Nevertheless, antidepressants continue to be
prescribed to children in ever-increasing quantities, in total contravention of
NICE Guidelines.
I have also researched the
over-prescription of medication for ADHD. This has been shown to lead to
conditions like bipolar disorder in teens, which in turn has been mis-medicated
with SSRIs. In 2015, I was contacted by a Human Rights organization, asking
permission to use my articles The Lost Children and The ADHD Epidemic as part
of a submission to the United Nations Committee on the Rights of the Child in
Geneva. In June 2016, the UNCRC published their investigation into children’s
rights in the UK. Sections 59-62 of the report dealt with mental health. Here,
the committee voiced their concerns over the over-medication of children. They
reported that ‘The actual number of children that are given methylphenidate or
other psychotropic drugs is not available,’ and that: ‘There is reportedly a
significant increase in the prescription of psycho-stimulants and psychotropic
drugs to children with behavioral problems, including for children under 6
years of age, despite growing evidence of the harmful effects of these drugs.’
One of their recommendations was to: ‘Ensure that prescription of drugs is used
as a measure of last resort and only after an individualized assessment of the
best interests of that child, and that children and their parents are properly
informed about the possible side effects of this medical treatment and about
non-medical alternatives.’ Earlier in 2016, the World Health Organization had
raised concerns about the rising level of antidepressants prescribed to
children in the UK and other countries. I don’t believe that the government has
made public its response to either the UNCRC or WHO. If prescribers in both the
public and private sectors continue to ignore the guidelines published by NICE
and the BNF, the numbers of adults and children who take their lives will
continue to rise. These deaths are preventable.”
—From Petition Ref MM
__________________________
“I was on Prozac 20 mgs for a little over
20 years. I was told by a psychiatrist I would need to take Prozac for life due
to a chemical imbalance. When my mother’s health declined rapidly, I was
switched to venlafaxine (Effexor) being told that Prozac was no longer working.
I had MANY debilitating side effects that my psychiatrist said had nothing to
do with venlafaxine. I didn’t find this out until I missed taking one
venlafaxine 150 mg capsule and couldn’t walk without hanging on to furniture
and walls.
That’s when I looked up venlafaxine
side effects and was shocked to see all my side effects for a solid year, which
I was seeing specialists for, were related to venlafaxine. I was LIVID! Last
week of March 2013, I told my psychiatrist to put me back on Prozac. She
bridged me, reducing venlafaxine by 50% for 2 weeks and adding Prozac 20-40 mgs
for 2 weeks. The first day of reducing my venlafaxine from 150-75 mgs were PURE
HELL! I was naive and didn’t know anything about withdrawals; no one told me
anything. My psychiatrist just told me to go to the ER, where they told me I
was going through withdrawals from venlafaxine and sent me home like it was
nothing. The ER doctor told me to stay hydrated and crawl in bed. I was shocked
that they let me get behind the wheel of a vehicle! I found myself driving on
the wrong side of the road driving home, only realizing it when I saw cars
driving towards me. Yet when I told my psych doctor I couldn’t drive, she told
me if I didn’t go to the ER she wouldn’t write me a note for work.
I came home and crawled in bed still
reducing my venlafaxine as told by my psych doctor. I wouldn’t wish this on any
living being. I had uncontrollable and severe shivering, jerking, sweating,
hallucinations and blurred vision, vomiting, diarrhea, dizziness, brain zaps,
heart palpitations and racing heart, body wreaked with burning pain, felt like
bugs crawling underneath my skin, vivid nightmares, my brain wouldn’t work to
even form a thought (COMPLETELY disconnected with body and earth). The only
thing I could do was endure this hell staring at the wall in front of me. If I
closed my eyes I had white dots coming at me. I had a vision, so clear it was
like I was there: I was in a crowd of people right after Jesus had been hung on
the cross. It felt like my brain and body was shutting down. If I was able to think
(form a thought) I would have ended my life and suffering in an INSTANT without
a second thought.
This has been the most cruel, mental
and physical torture anyone can endure. I went through this alone, bedridden,
rarely ate because I couldn’t get out of bed, when I did it was SO HARD to
nibble on crackers, fix a piece of toast, cereal or microwave soup to eat and
everything I ate I either vomited or it went right through me. After going
through a hell of withdrawals I knew nothing about, I had a long list of
symptoms and was suicidal. Psych doctors kept trying me on multiple drugs (1-4
at a time) only to make me worse for the next 6 months. I finally told my psych
doctor that I would only take Paxil 20 mgs (I just picked one) and see what
happens, since NOTHING was working. Paxil didn’t work either, but I was
desperate and felt like I needed something but didn’t know how to fix myself
and doctors didn’t either. I lost my job, family, friends and would’ve been
homeless if it wasn’t for my savings over the years.
Out of desperation I made a Facebook
group called “EFFEXOR (venlafaxine) Side Effects, Withdrawal and
Discontinuation Syndrome” not expecting anyone to join and now have over 3K
members. It took me almost a year to figure out what I was experiencing was
Post-Acute Withdrawal Syndrome (PAWS), also known as Protracted Withdrawals and
the reason I couldn’t get any medical help, attention or support is because
it’s not listed in the DSM-5 manual. My life as I knew it came to a screeching
halt in pure torture overnight due to our failed so-called healthcare system
and medical professionals. It’s been 4 years and 8 months of hell (with
numerous debilitating symptoms). Currently, I can barely take care of myself;
showering approximately every 3-4 weeks, sometimes longer; can’t fix food to
eat, pay bills, rarely brush my teeth, etc. I have an in-home counselor that
comes once a week for 11/2 hours to check on me and help me with things like
getting my mail, getting me groceries, etc. My house hasn’t been cleaned since
all this happened to me. On top of my numerous symptoms, I still deal with my
withdrawals which have stolen all my desires, goals, you name it. I feel
completely blank inside. If you want a list of current symptoms I can put a
list together for you.
All of this could’ve been avoided if
our healthcare system and so-called professionals informed patients; about
withdrawals, acknowledged that antidepressants can cause withdrawals and
protracted withdrawals, knew how to taper patients slowly and safely off
antidepressants (10% or less every 3-4 weeks that I’ve read about), and STOP
prescribing drugs to try and cover up withdrawal symptoms just to name a few.”
—From Petition Ref JJ
__________________________
“As a result of taking antidepressants, I
now have multiple severe disabilities that include 13 different areas of visual
distortion, balance issues, visual processing issues, co-ordination, sleep
issues, digestion issues, joint issues, memory issues, a mast cell problem,
neuro degeneration/dysautonomia that was diagnosed by a private clinic in
London (letters can be produced if necessary), and multiple chemical
sensitivity among many other symptoms. The informal dialogue that comes about
when a patient is in a doctor’s surgery is hugely telling of the lengths that
doctors will go to ensure that the patient is guilted into taking
responsibility for the situation in which they find themselves.
When I visited my doctor for the
umpteenth time only to be told that my symptoms were very complex and a solution
was not something he could give me, he said to me: ‘I see a great many people
living miserable lives, but THEY just get on with it!’ I asked to speak to a
psychiatrist and said to him (quite angrily which I think is wholly
understandable) that they have no right to hijack and dismantle peoples’ lives,
he responded ‘I think you’ll find that we already have!’ When I asked an
earlier doctor what the outcome would be if I were continually prescribed
stronger and stronger medication (as was happening), he leaned back in his seat
and told me the name of the mental health ward at the local hospital. When my
brother-in-law voiced his concerns to my GP that he didn’t know best how to
help me, as I was tapering Effexor, and that I was hysterical and paralyzed
with fear when he (my brother-in-law) spoke at length with me during the night
on the phone, the GP responded, ‘She has transferred her dependence of the drug
onto you! If I were you, I’d put a block on your phone line so she can’t call!’
The psychologist who saw me for 2 years and stated firmly to my GP in a letter
that he believed my difficulties were of a physical origin and not
psychological. When he retired from his position, he shook my hand and said to
me, ‘You do realize, don’t you, that your life has changed forever?’
Perhaps the most stunning words or
gesture I’ve seen is when I went to the Scottish Parliament and spoke with
Scotland’s Minister for Health and Wellbeing along with one of the principal
medical advisers to the Scottish Government. I recounted a horrifying account
that spanned 10 years of symptoms that were unimaginable to most people. It was
obvious that at a humanitarian level, they were moved and empathized deeply
with the challenges that I have been given. At the end of my dialogue, expecting
everyone to get up and leave, the adviser leaned across to me, brought their
head down to my level, reached for my hand, shook it, while they looked into my
eyes and said, ‘I’m so very sorry!’ This is where I struggle: clearly this was
a personal apology and not a professional apology.
People need to understand how this
can be the case that harms can be done, apologies can be given, yet for them...
this is an end to the matter? Why is this? Because their lives haven’t come to
an end! Well it doesn’t come close! It doesn’t even begin to cut it... not for
me, and not for the many thousands of people who are and have been harmed week
in, week out, year in, year out!”
—From Petition Ref RRR
__________________________
“I want to speak firstly about how when I
first realized there was a huge problem that the apparent ‘neglect’ would show
itself and the good doctors would have all hands on deck saying stuff like:
‘There’s a really big problem here... somethings very wrong... one of our
patients has become disabled in many areas of her functioning... and all that’s
happened is that she took a drug under our care, under our instruction and with
trust in our word that it is safe! We need to look into this because clearly
something’s gone wrong!’
Fast forward 10 years, and I’m still
waiting, locked in a reality that I don’t want to be in! The whole idea that
doctors have been simply neglectful is long since gone from my vocabulary! How
stupid was I for thinking that my doctor would be saying to themselves that it
is morally, ethically and medically wrong to turn a functional person into a
disabled person even if they experience sadness and from time to time anxiety.
It’s worth mentioning here that any sadness or anxiousness I experienced was as
a result of external stimulus! Which is wholly human and completely
understandable.
Now, however, there is no chemical
stability inside my body! Whereas before chemical stability was something that
I took for granted! What staggers me beyond words is this: All these mind
altering drugs are just what it says on the tin! Mind... Altering... Drugs!!!
So why then, when a patient has taken these drugs and they are in a state of
suffering clearly tortured by the legacy, do doctors think it’s okay to raise
their eyebrows and imply to the patient that this suffering is the patients
fault? Geez!!! The drugs are targeted DIRECTLY at the brain and the workings
therein!
As doctors keep schtum throwing in a
few medical terms for good measure, friends and family look on in astonishment
not knowing what to make of behaviors that sit totally at odds with the person
they have known! It’s been said that the lie is never in what you ARE told by
your doctor—it is in what you are NOT told! This would ring true, because it
appears to me that doctors smugly assure patients that the drugs are safe to
take and what I believe they fail to tell patients is that the drugs are not
safe to stop! That little nugget doesn’t become apparent to the patient until
they try to come off the drug. By which time, the resultant
behaviors/symptoms/legacy is medicalized as a separate condition requiring?
You’ve guessed it! More drugs!!!
I remember the words of someone who
worked at the Council for Information on Tranquilizers Antidepressants and
Painkillers (CITAP) who said ‘Imagine you have seen a color that is a totally
new color that has never been seen by anyone before only you can see it! How
would you go about ensuring your description ensured your friends, family or
colleagues could also see it?’ The problem with this is that no matter how hard
you would try, it would be pretty much impossible for them to ‘get it!’ Why?
Because, they have no point of reference for it; they’ve never seen it before,
so any known descriptors are of no use to them!
Equate this to a person’s neurochemistry
being messed up with the drugs! The carnage left behind has affected all of
their bodily systems. Psychologically they feel distanced, weird, messed up,
disturbed... all of the above, and their actions and behaviors reflect what
they are experiencing internally! Again, I come back to the previous example.
Unless you have experienced this, how can friends, family and colleagues
possibly relate?
This inability of family, etc., to
relate to these challenges suits the state to no end! All they have to do is
shrug their shoulders, throw around a few random labels that they made up
(honestly, it’s true!) and do nothing and allow the patient to demonstrate the
system’s ‘original findings’ which are that the person has a mental illness.
The evidence against psychiatric
claptrap is mounting and will only continue to mount up so that the filth that
is known as psychiatry will float to the top where everyone can see it! As for
myself, I want to speak about my doctor/patient relationship and how it has manifested
over time. My doctor’s practice has asked me to leave the practice and go
register with another doctor. They have suggested that I register at a practice
near a caravan that I spend time in! It’s quite an unusual thing to happen
given that my home is 250 yards from the practice. The lengths that the
establishment will go to remove discomfort from their line of sight is
astonishing.
I want to finish up with a quick
summary. Nearly a decade off these drugs, still severely disabled, I have major
visual disturbance in 13 different areas of my vision.
Burning/stinging/crushing pains in my skull 24/7, ice packs needing changed
every 20 minutes for the last 10 years, balance issues, memory issues,
digestive issues, cognitive issues, sleep issues. I’m still waiting for my two
week withdrawal to come to an end and wandering in the long grass looking for a
doctor, having been told to go elsewhere.”
—From Petition Ref YYYYYYYY
__________________________
“In 2000, I experienced pains in my wrist
and arm from keyboard overuse in my job at work. I presented to my doctor for a
prognosis. I want to make it clear that at this point in time I had never
experienced any kind of psychological distress neither was I emotional. The
doctor told me that I had a pain in my arm because I had a chemical imbalance
and that I needed to take a series of medicines until I found the right one for
me. Having never smoked, drunk or taken any kind of drug, legal or illegal, I
asked if these were addictive. I was told no, they weren’t. I asked if they had
any side effects. I was simply told maybe you might experience a dry mouth. I
did not know that these drugs were used for psychiatric purposes.
I was given a sequence of drugs to
take to heal my repetitive strain injury in my hand, amitriptyline,
nortriptyline, venlafaxine, and clonazepam. I worked my way through these
medicines over several months finding they were no use and then quit them.
Several months later, I start to experience uncharacteristic emotional
manifestations. I started to experience unusual crying spells and had what I
would describe as my first ever kind of panic attack. I didn’t even know what a
panic attack was. I presented back to my doctor and said that there was
something wrong with me but I don’t know what it is. I was immediately given a
prescription for paroxetine assured it was not addictive and no side effects,
there was no clinical assessment done of any kind. I cannot for the life of me
understand how it came about but I stayed on this drug with several failed attempts
to quit it until January 2010. The doctor just simply kept renewing scripts all
of this time. No discussion was ever had on getting off this drug.
In January 2010 I told him I wanted
off and was told, ‘Okay, just take as much paroxetine as you like.’ In other
words, just cold turkey it. I knew this was not correct and left frustrated yet
determined to break free of this so-called medicine. After a nine month
self-calculated taper, I was in a very dark place and presented reluctantly
back to the doctor to get answers for what I now know was horrific withdrawal
symptoms. The doctor seemed unaware of withdrawal symptoms (or didn’t want to
know) with coming off paroxetine. On trying to describe these symptoms, I was
told I had an underlying depression. I had never used that word before and
replied, “That is not correct.” I was referred to a psychiatrist. The first
thing I said to the psychiatrist was, ‘Are you aware of any issues with people
coming off paroxetine.’ This was his reply: ‘If there were issues with people
coming off paroxetine, people would be suing the drug companies.’ I interpreted
this as no there were no issues with people coming off paroxetine so the
problem must be myself. My inner conviction told me this was not correct,
either. I left determined right then and there not to engage with the medical
profession again. I was on my own.
The next few years were the most
difficult of my life. The mornings were pure hell. Forget trying to hold down a
job each day was a struggle just to survive. Uncontrollable restlessness
uncontrollable psychological and emotional distress, sobbing and suicidal
ideations were the norm daily for the next few years. I would be the last
person in the world to commit suicide yet I consider it a miracle that I’m still
alive. It wasn’t until in my seventh year of being drug-free that I was able to
return to work on a part-time basis. I was unable to pursue my sports passions
during this time also. I used to be a top level amateur badminton player. I’m
now in my eighth year of being drug-free and trying to pick up the pieces and
get on with my life.
I’m unable to sleep with any
regularity am seriously sexually damaged and my beautifully trained tenor opera
voice has been taken from me. I now find it very difficult to sing and
extremely tiring when I try. So much so that I have completely given up this
prior passion. It has been stolen from me. I have a very deep sense of being
hoodwinked and betrayed by the medical profession. I’m also outraged and
heartbroken that I can now see in hindsight that I was made a drug addict by
stealth trapped in a mind numbing anosognosia Kafkaesque world for almost a
decade!! It is totally unacceptable to me that SSRI drugs are being prescribed,
they should be banned. It is totally unacceptable to me that doctors do not
acknowledge withdrawal symptoms of these drugs which for some people like
myself can last for years.
Any attempt to get answers for the
withdrawal trauma results in intelligence insulting labels and comments from
doctors. Doctors should be deeply ashamed at their stupidity. And of the life
altering harm they are doing to innocent, trusting people.”
—From Petition Ref FFFF
__________________________
“I apologize that this may be upsetting to
read but I am in such a bad condition three years after an adverse reaction to
Prozac. To recap, the adverse reaction felt like something had fried in my
brain, taking with it connections to life past, family, interests, personality.
It feels like my whole sense of self is gone, and in its place there is this
black hell in my head. There are so many mental and physical symptoms that are
beyond human endurance. I endure every minute something even worse than the
worst suicidal depression I ever had (with hindsight, always in antidepressant
withdrawal) and what a struggle that was. I have already spent 16 years
battling antidepressant side effects and withdrawal (misdiagnosed as relapse)
and doing what I could to try and manage the condition that the NHS had caused
but which very kindly then gave me no coping strategies.
This condition from SSRI adverse
reaction is way beyond what I experienced as depression or anxiety in SSRI
withdrawal. I am only 35 and I’m hysterical often because I feel pushed to end
the only life I was given. People that are ending their lives from SSRI
withdrawal or reactions are being pushed to literally jump to escape
unimaginable agony. Make no mistake about it, this brain torture could not
exist naturally. I would like to say more about how doctors and other health
care professionals have responded to my assurance that the drugs caused this. A
GP got really angry with me and she thinks it is all psychosomatic. It feels
like a chemical has burnt and is continuing to burn my brain. This acid burning
brain is common in SSRI reactions. An occupational therapist said, ‘Even if it
is a brain injury, there is research that people who can maintain a positive
mental attitude do better.’ How can I be positive if I have something that is
even more intolerable than suicidal depression? So, the focus goes back to the
patient who is like this because they are not doing enough to ‘help
themselves.’
I went to my most recent GP
appointment to ask specifically about the protocol on prescribing
antidepressants. I asked the doctor if by prescribing an antidepressant, they
think they are correcting an abnormality in the brain. She did not answer me
directly, just that these drugs are complicated and that is why patients need
to be monitored. And that the risks and benefits would be explained. But it is
clear from our petition that even if patients are monitored the adverse effects
side/effects are not being recognized. And I was never told that the condition
I am in now could happen. When I asked if patients were given other options
before antidepressants, the GP said that talking therapies would always be
offered alongside antidepressants. My question is, ‘Why are talking therapies
not tried first?’ Her exact words were, ‘If a patient wants an antidepressant,
then we will give one.’ Where else in medicine would someone be prescribed a
drug because they ‘want one?’ And all the while she was interrupting me to ask,
‘What about psychotherapy?’
There is a letter on my file from a
psychotherapist saying they did not feel they could help. The doctor also said,
‘Even if it is a brain injury, people can still live a life.’ And what about
volunteering, keeping busy? I was busy when I was first prescribed an
antidepressant. I struggled and struggled for 16 years keeping busy but with
the adverse reaction to the second drug there is no way I can do this. I have
had to give up the few things I had left in life. I struggle to see family with
the severe distress I’m in and out in public even more so. I don’t think there
are any more adequate words in the English language to describe what I have.
All I can say is it is torture. The NHS definition of depression is ‘unbearable
sadness.’
Screaming because it feels like
something is being drained from the brain causing something so low no human
should have to experience, I don’t think fits the NHS description. It is very
strange that when I tell doctors something has happened in my brain that I
absolutely cannot live with, the response is, ‘There are things you can do to
help yourself.’ They know that I’m on the edge of suicide every second of every
day and if they could feel it they would absolutely know the drug caused this.
I am absolutely certain no anxiety
or depression could ever feel like this, so this leads me to wonder on what
basis are these drugs ever prescribed? If someone is suicidal? I’m severely
suicidal from the drug; now I’m being told that I can ‘help myself.’ If someone
as bad as me could deal with their condition naturally, then surely these drugs
shouldn’t have a place at all. Of all the years I have spent in and out of
crisis centers for withdrawal induced depression and anxiety, one nurse said to
me, ‘You just have to keep trying things and hope someday you will find the
answer.’ What is so shocking and astounding is that all these years I felt so uncomfortable
on the drugs and every time I tried to come off them, neither I nor my doctors
knew I was suffering from withdrawal effects and so clearly the answer was not
going to be found in anything other than the drugs themselves.
Thank you for reading and I hope
this drug induced prescribing hell stops soon before many, many lives are
taken.”
—From Petition Ref DDDDDDDDD
__________________________
“I was prescribed venlafaxine by the doctor
I was assigned at the Mother and Baby unit for perinatal mental health. I was
diagnosed with Post Natal Depression, (PND) and anxiety at three months
postpartum. I was referred by my GP to the specialist unit.
I was prescribed venlafaxine because
the citalopram I was originally put on didn’t seem to be working. I don’t remember
the doctors telling me anything significant about coming off venlafaxine. They
may have mentioned that I would need to taper off it gradually but nothing
more. I was not really in a fit state to question the medication I was being
given. I trusted the doctors knew what I needed at that point and I do believe
it helped me out of a very bad place.
I decided to start reducing my
medication after 18 months. I was taking 37.5mg twice a day (the smallest dose
tablet available). On three separate occasions over almost a year I experienced
what would be described as a relapse but was in fact my reducing too quickly
and it too large amounts, cutting up the tablets. This was my only option as
far as I was aware and with no guidelines to follow. On these occasions I
experienced: insomnia, extreme anxiety, depressive thoughts, suicidal thoughts,
uncontrollable crying, complete exhaustion, lack of energy and motivation,
anger, headaches, and stomach problems. All things I had NEVER experienced
before taking this medication.
After this, I was lucky to have a
very understanding GP who prescribed me the liquid version. I then began a very
slow 10% reduction, holding for 4—6 weeks each time. But the symptoms were
still intense and often debilitating, happening every time I reduced the dose,
a wave of withdrawals lasting days, sometimes weeks. Once I began to feel more
human again I would prepare myself then do it all over again, I counted 50
times! All done whilst looking after a small child.
In desperation to get off the
medication, on a couple of occasions I tried to speed up the tapering by
reducing a larger amount or shortening the time spent at each dose. Every time
it backfired on me, leaving me with unbearable symptoms unable to function. I
honestly feel the process of withdrawing has been much worse than the original
PND. Through the process I was 100% sure I no longer needed the drug for my
mental health, but I could not stop taking it. I feel the tapering process has
robbed me of the past four years as a mother, wife and friend. I hope this
helps to getting something done about the problem of over prescribing this drug
and the support given to those wanting to be rid of it.
I am thankfully, finally, off this
poison. I took my final dose of around 0.25mg in the summer. In total it took
me 3.5 years to taper off venlafaxine. For me, I feel let down by the care I
have received once I started to taper off the medication. If I’d known how long
and difficult it would be I would have started the taper a lot sooner. I would
have appreciated more support and understanding from the doctors that
originally prescribed it. I understand I am definitely one of the luckier ones,
as my GP has been sympathetic and prescribed me the venlafaxine liquid in order
to taper very slowly after I had two failed attempts at cutting down the
tablets.
I think there must be better support
and ways to help patients that want to get off this medication. Instead of just
being told that their original health problems must be returning and therefore increasing
the dosage, which I have personal experience of. I’m certainly not completely
against the use of antidepressants. I desperately needed help, BUT I don’t
agree how they are sold to vulnerable people, as a quick fix, with no warning
of how addictive they are.
You can’t expect being on
antidepressants to necessarily be a shortterm thing, you may be lucky, or like
me you may be trapped in a nightmare for years. Do your research; don’t take
the decision to start antidepressants lightly. There needs to be support for
those who want to reduce or stop their medication, at the moment there is zero
support in place. The guidelines are incorrect, resulting in people finding it
too difficult & staying on them because there is no alternative. I’ve
experienced firsthand professionals telling me that I must be relapsing.
Of course, not everyone finds
tapering as difficult as I have. It depends on the drug, the dose, and of
course the person. We are all different.”
—From direct submission
__________________________
“I had experienced anxiety, panic attacks
and low moods throughout my adolescence, after having been bereaved in my
childhood. I was first prescribed antidepressants at age 19. Sertraline
certainly boosted me: I felt alive and confident, and able to throw myself into
university life, socializing and making friends. There was a kind of hysterical
energy about me. I was young, and a student, and I was certainly not taking the
drugs consistently at exactly the same time each day, and sometimes missing
days altogether. On days and weeks when I felt low, I would double my dosage to
give me a ‘boost’.
I vividly remember a time I ran out
and missed a day or two and was so debilitated by the nausea and dizziness I
felt unsteady, had blurred vision when I moved my head from side to side, and
walking up the stairs caused motion sickness. This terrified me, but I still
didn’t appreciate the significance of this as dependence and withdrawal.
At age 21, I stopped taking the
sertraline. I quickly started suffering panic attacks and had a constant
feeling of doom. I moved out of my shared flat and back home to my mum’s, just
before my 22nd birthday. At the time, I wasn’t aware of withdrawal, but was
quite aware I was having a break down. I experienced sleep paralysis, night
sweats, panic attacks and a lot of suicidal ideation. In retrospect, now that I
know withdrawal, I can see I was experiencing sertraline withdrawal from
stopping ‘cold turkey’ and my doctor should have reinstated the drug and
tapered me off it slowly. Instead, I got a new prescription for citalopram and
a referral to a psychiatrist. The psychiatrist concluded I had ‘treatment
resistant depression’ (because I had tried two SSRIs) and prescribed
venlafaxine, an SNRI which was more sparingly prescribed. I didn’t receive any
warning, I wasn’t spoken to about risks or side effects at all, and I wasn’t
asked whether I had any plans to have children.
At the time, of course, I didn’t
have any clue that these drugs were not entirely benign, my experiences had
been solely attributed to me and my mental health. Venlafaxine worked miracles.
Within two months of this psychiatric assessment, I was at a festival for a
whole month working and having fun with friends I’d not seen for the duration
of my six month breakdown. Time passed, and these were happy years. I was so
scared of what I’d experienced I was cautious of ditching the drugs. I was busy
and young, and worked abroad for a year, too cautious to change my medication
whilst abroad, I planned to stop taking it once I moved back home. I never
intended to take it long-term, but I took it successfully for three years with
no idea as to the dependency I had acquired.
Upon moving back at age 25, I moved
to a new area and had a new doctor. My prescription was changed; I was put on a
cheaper, generic form of venlafaxine, which was quick release. I wasn’t
instructed to take it any differently and I was only prescribed enough for one
daily dose every 24 hours. However, the half-life of quick release venlafaxine
is only 8-12 hours so I was unknowingly going into withdrawal every evening. I
took it like this for nine months, completely unaware that my new nervous
breakdown was caused by my drugs. This was nine months of insomnia, night
sweats that soaked me through, rage and violent impulses, suicidal ideation,
obsessive and paranoid thoughts. I had moved in with my boyfriend for the first
time, and I was horrible to live with; I spent most nights awake and in
turmoil, or finally asleep on the concrete floor of the kitchen because I was
so hot and sweaty.
Amazingly, my boyfriend started
keeping a diary of my moods, and told me he found a pattern. I was okay most of
the day, and took a steep decline into mayhem in the early evening. He said he
saw in my eyes when I had descended into upset or anger and was unreachable.
This is when we looked at my drugs, and understood the meaning of ‘quick
release.’ I feel so stupid now, but both a doctor and a pharmacist wrongly
prescribed the medication and how to take it. I consider this gross negligence
on their part. This experience not only traumatized me and eroded my confidence
in my own capacity to cope, but I now believe that it messed with my nervous
system so much by going in and out of withdrawal, that it hyper-sensitized me
to the drug and future withdrawal. I’ve also discovered, through trial and
error and GPs having persistently pressured me off of the brand Effexor and
onto generic versions of venlafaxine at different times, that I am affected by
the change in brand. I’ve been made aware through my research of the
difficulties and differences in the use of generics, which have a negative
effect on many patients.
Age 26, I was now back on the
original 75mg Effexor brand extended release. I was too terrified of what had
happened to me to want to stop taking antidepressants, I was convinced what I
experienced was my own madness and I couldn’t cope without medication. The
rhetoric around antidepressants, and what I was being told by GPs, was
certainly that I may need the drugs for life. But I found it hard to stomach
that I may be so unwell I would need to be medicated for life, and yet still
received no specialist care from mental health professionals, how can a GP
decide I need to be medicated for life with no further investigation? A couple
of years of unstable life and work circumstances made it difficult to believe I
would ever be in the right time and space to stop taking medication. I never
really stabilized after that nine months of on-off withdrawal.
Finally, I was in secure employment,
feeling brave and happy enough to ditch the drugs. I spent a year weaning off
from 75mg, to 37.5, to 25 and then 12.5 to 0mg. Even with an unexpected and
sudden redundancy in the middle of it, everything was well until I got to
12.5mg. At this point I was working abroad again in a refugee camp, and it was
probably the worst of circumstances I could have continued my taper in. But
STILL I had no idea about withdrawal, I didn’t know how delicately I had to go.
My GP had been unhappy with my tapering plan, saying I didn’t need the smaller
doses because they weren’t manufactured, and discouraging me from opening my
capsules to get down to the 25mg and 12.5mg doses. I was cautious, so I
continued with this taper regime that my GP thought was ‘unnecessary’. So on
the facts presented to me by my GP, I had no reason to believe the taper was
unsafe for me and I continued.
Things started to unravel at 12.5mg,
which I thought was shock and secondary trauma of being in a harrowing
environment. Delusions and sleep disturbances began at this point. Vivid
nightmares, the feeling of doom and being unsafe began to accompany me
everywhere, and I had persistent migraines and vertigo. Still, I continued my
taper. Why, why, why?
Because I was so completely and
utterly ignorant to withdrawal and had a lack of regard for myself and how I
was feeling. I also believed everything I was experiencing was a result of my
context, and whilst I would now say it was absolutely contributory and my mind
had plentiful material to play with, I believe the one wouldn’t have existed
without the other.
Although I’ve no doubt I wouldn’t
have become quite so ill if I’d been in a safer, more stable environment, I
also wouldn’t have become so ill organically without the chemical harm that
came from withdrawal. I finally stopped taking it, jumping from 12.5mg to 0mg,
a taper which my doctor had thought was too slow. I don’t know what date I
stopped, or how soon after I became acutely unwell, but I developed psychosis
within days.
Thankfully, I have an astute and
caring partner who did everything he could to keep me safe and get me help. I
saw my GP twice in this time, during which he asked if I was ‘planning to do
anything silly’ when I disclosed my suicidal ideation, and twice he resolutely
refused to refer me to psychiatry when I asked. After some psychotic behavior
and hallucinations, my partner made an urgent self-referral for me and I was
assessed by the community mental health team the following day. They were less
than helpful, and still no one mentioned withdrawal, but I got back on
venlafaxine 37.5mg that day and also walked away with diazepam. That put an end
to the kindling psychosis. My psychic pain, panic, insomnia and suicidal
ideation continued less dramatically for a further six months, during which
time my partner was asked to stop calling the community mental health team as
they would offer no further support. Eventually I went back onto my original
dose of 75mg of Effexor (brand of venlafaxine) just before my 30th birthday and
finally stabilized.
It’s now been over four years since
I went back onto venlafaxine after the psychosis brought on by withdrawal. In
this time I’ve researched and read about antidepressant withdrawal. I’ve
realized my taper was far, far too fast, despite what my doctor said. I’ve read
about and spoken with hundreds of other people who have been clinically harmed
by venlafaxine. I’ve tapered down slowly at 10% tapers from 75mg to 15mg of
Venlafaxine, and found myself stuck unable to go any lower due to the extreme withdrawal
symptoms and return of suicidal ideation. I’ve started and quit a professional
training, unable to continue because of the withdrawal effects. I’ve had to
work part time in less stressful roles, giving up my career. I’ve wanted to
have a child, and come to find deeply disturbing anecdotal evidence and
research studies that point toward antidepressants being very harmful in-utero.
I am not only concerned about miscarriages and having ten fingers and ten toes,
I’m worried about the lifelong effects of these drugs on the next generation,
which we don’t yet know about. I’m concerned that if this drug has caused such
havoc with my central nervous system, what would it do the developing nervous
system of a fetus and what long term effects will that have? I am now not naive
enough to imagine there wouldn’t be any.
I’ve felt that everything in my life
is on hold because of the trauma these drugs are causing me. I’ve been
desperate to get off venlafaxine as swiftly as possible, so I could begin to
think about moving forward with my career and having a family, but found myself
stuck at 15mg with debilitating physiological and emotional withdrawal effects
if I went any lower. I decided to ‘bridge’ onto fluoxetine (Prozac), a method
advised by Dr. David Healy, and I experienced such migraines and vertigo that I
had to take a relatively much higher dose of Prozac to counteract the
withdrawal symptoms. Lucky for me, this ‘bridge’ worked and I was able to ditch
the venlafaxine entirely -however I am clearly so sensitized to withdrawal I
couldn’t get off the Prozac as quickly as the bridging method suggests. The
tapering off from 20mg which I’ve been doing for the past fourteen months has
been challenging. The same withdrawal exists for me, but it is more manageable.
With each 10% taper I get around two weeks of withdrawal symptoms, often this
has verged into suicidal ideation. I’ve been managing my symptoms with diet,
exercise, psychotherapy, holistic therapies and supplements.
I have still received no meaningful
or helpful care from my doctor, and no follow-on support from the psychiatrists
who saw me in 2016. I’m still waiting for this nightmare to be over, and once
it is I will need to wait some more to see if I am truly stable before I embark
on any journey to having a child. I wonder why, as a young woman taking
antidepressants for the entirety of my twenties, I was never warned about
withdrawal or spoken with about the effect antidepressants would have if I
became pregnant? I am so grateful I am not one of the tens of women I have
spoken to who have become pregnant only to be withdrawn swiftly from their
antidepressants due to the risk, their doctors ignorant of the harm of
withdrawal. I am fearful that I may be more at risk of post-natal depression
and psychosis, and vulnerable to having to accept medication once again. After
my experience, I believe it’s imperative we achieve informed consent for
everyone who is offered antidepressants, to include an awareness of the
likelihood of dependence and withdrawal, and for doctors to have a conversation
with all women around their reproductive rights. I think it’s imperative that
every time someone stops an antidepressant and experiences worsening mental
health or physiological symptoms, that doctors are well informed enough to
recognize withdrawal. To taper them slowly and let them know there will be
adverse effects, rather than simply prescribe another drug and put the symptoms
down to their mental health condition. I was told that I was experiencing a
‘relapse of depression,’, which was proof that I need the medication long term,
but I never understood how I could relapse to a place I’d never been before. We
need withdrawal to be researched and understood so doctors can recognize and
treat it effectively. So treatment might empower patients rather than leave
them believing they cannot be well without drugs, all the while experiencing
unknown harm from those drugs.”
—From direct submission
__________________________
“I am suffering from the effects of
withdrawing from antidepressants, having taken them for over 20 years. I was
originally prescribed these drugs to treat headaches, the drug was venlafaxine.
Over the years, the dosage was
increased to 225mg per day. During this period, I was also prescribed another
antidepressant, amitriptyline, which I was told also acts as a pain relief for
the headaches I was experiencing. At no point was I advised, throughout these
20 years, of the impact of withdrawing or a review of my medication other than
to increase the dosage if my symptoms seemed worse. In hindsight and from
research, I now believe my symptoms were that of withdrawal rather than the
original complaint getting worse.
About 31/2 years ago, I started
having anxiety issues about my deceased father. My GP arranged for an appointment
with a mental health facility to see if they could offer an alternative
treatment, as I expressed I wanted to decrease the venlafaxine because I was
tired and unable to function some days. After speaking to a clinician at the
center, who liaised with a senior consultant, the outcome of this visit was to
increase my 225g daily dosage!! My GP suggested a different antidepressant (he
thought I had been taking them for too long, which is an understatement) and
gave me a timetable to taper off venlafaxine before starting the new drug.
However, the timescales were too
drastic and the amount of reduction made me feel very unwell. I was stuttering
and lost all ability to function. He also prescribed Valium to cope ‘as and
when’ I needed them. Again with hindsight this practice of poly-drugging makes
the impact of withdrawal much worse. I was not advised of any dangers about
coming off the drug so quickly and was left with devastating results to my
health. I couldn’t work and have never been able to resume because of the
impact withdrawal has had on my life and family. My husband had to a stay off
work to look after me for 5 months because I was very poorly with the
withdrawal symptoms but he had to go back to earn money for our mortgage and
bills.
Eventually we lost our lovely home
because of the impact withdrawal has had. I still suffer after 31 months of
stopping the drugs from horrific and debilitating symptoms. I have no life. I
battle to survive each day against thoughts of wanting to end this torment but I
won’t because I know this is withdrawal from a toxic drug and I never suffered
from any of these symptoms before taking it. I went to my GP to find relief
from the headaches I was experiencing, not for depression. During my nursing
career, I was never given any guidance when dispensing antidepressants in terms
of its side effects, long term effects or subsequent withdrawal. It’s
incredible that a prescribed drug, taken by thousands of people, can cause such
devastation, yet the health service is oblivious to this widespread suffering
and continues to be in denial.
These drugs should never have been
prescribed in the first place and should be banned in the future before more
lives are taken.”
—From Petition Ref DD
__________________________
“I have been supporting and caring for my
wife through her severe experience with being prescribed an SSRI
antidepressants. The medical profession has failed us in the following ways for
over two decades: 1) Unnecessary prescribing of an antidepressant for
situational anxiety that could of being resolved through other therapies; 2)
Failure to identify serious neurological side effects early on in the
treatment. When seizure type side effects were reported to our local doctor,
they were dismissed and we were told it was just anxiety, however later on it
was diagnosed and confirmed as extrapyramidal side effects from SSRIs. These
have developed into debilitating movement disorders; 3) Inadequate knowledge of
withdrawal symptoms leading the doctor to think it was the original condition
but in fact the drug. The withdrawal symptoms have been far worse than the
original problem. This has led to her dose being increased and yet again
chronic use as developed.
As a consequence of all of this, my
wife’s health has deteriorated rapidly over the years. She has gone from a
normal functioning person, working and studying to being completely
incapacitated. She has always taking care of herself through diet and exercise
and does not drink or smoke, but yet a legally prescribed pill has left her
this way. This has impacted us financially as I have to work longer hours to
make up for the loss of income. Also the time taking from work to care for her.
Emotionally, this has been
devastating, to watch someone suffer at the hands of these drugs is truly
heartbreaking. When the withdrawal and side effects from these drugs are so
severe that a person is so incapacitated to the point of not even being able to
feed themselves or stand up, you have to ask yourself what an earth are these
pills doing to someone’s brain. Are they the new age lobotomy? Do doctors even
know the mechanism of how these drug works? Mr. Marsh, who is now one of
Britain’s most eminent neurosurgeons, says lobotomies was simply bad science.
“It reflected very bad medicine, bad science, because it was clear the patients
who were subjected to this procedure were never followed up properly. If you
saw the patient after the operation they’d seem alright, they’d walk and talk
and say thank you doctor,” he observes. The fact they were totally ruined as
social human beings probably didn’t count.
So are we not just replacing
surgical instruments for potent chemicals? I ask again, is prescribing these
drugs just a new age lobotomy? It is clear that prescribing antidepressants
will continue as the medical profession is so greatly influenced by the
pharmaceutical companies. They seem to justify this prescribing by still
claiming that it is necessary due to a chemical imbalance in the brain, even
though there is no evidence to prove this theory. The fact that my wife goes to
the doctor to get her script filled and is never asked how she is on the drug,
any side effects occurring etc. just shows there is no interest or concern in
getting her to discontinue the drug and highlights the need for it to be used
long term. This is certainly not just the case with just a handful of GPs, it
is with a majority of them over the years. We have moved house and still with
the change of doctors we get the same response. Again, why are these doctors so
uneducated about these drugs?
After going on online support forums
with my wife, we found she was not the only one being severely affected by
these drugs and that many people have similar stories. I certainly don’t feel
like she has just fallen through the cracks and is a rare case, she is just one
of many who are suffering in silence. If the medical profession still insist on
prescribing these demon drugs, there should be at least stricter guidelines for
the reason for prescribing and certainly emphasis on discontinuing the drug
after a certain time. Apart from profiting from money, I will never understand
why anyone would want to chemically mess with the delicate neurotransmitters in
someone’s brain. The fact that I learnt that these drugs were only trialed for
six weeks was pretty scary, so what are these drugs actually doing long term?
Again, are we heading into lobotomy territory?
It was once considered that Valium
could not cause addiction and withdrawal; to me it just sounds like history is
repeating itself. Pharmaceutical companies must be laughing all the way to the
bank because everyone is so fooled into their great business plan. Let’s use
the doctors as uneducated pawns to prescribe the drugs and get people dependent
because they can’t discontinue. It appears that when any problem arises with
these drugs no one seems to want to investigate or take responsibility for it.
They either put the blame back on the patient or blame is passed in a circle to
the doctor, the FDA, back to the patient again but never ever THE DRUGS. There
needs to be a thorough investigation into the prescribing and monitoring of all
psychiatric drugs in the medical profession. In addition, informed consent of
exactly how the drug is supposedly helping their condition, the side effects and
risks involved.
Another area that needs to be
addressed is the lack of knowledge about withdrawal. Doctors seem to think that
4-6 weeks is a sufficient time to discontinue psychiatric drugs; this is the
equivalent to abruptly stopping or going cold turkey, particularly for someone
who has been on the drugs for many years. Laurie Oakley’s Pharmaceutical Rape
series on Dr. David Healy’s website states exactly what’s happening. We have
the cast of characters: the violators (marketers, approval of medicine etc.);
the accomplices (medical professionals, prescribers); and the victims (people
who experience, physical, emotional and mental suffering from these drugs
without given consent of the dangers of these drugs). As with sexual rape, the
victims of pharmaceutical violation are everywhere, walking among us
unrecognized. Many may not even connect what they experience to their
medications. This is a violation involving physical, emotional, mental, social,
and spiritual damage at the hands of those holding power over medicines, who
deny any wrongdoing and remain free to do the same to others”.
—From Petition Ref AAAAAA
__________________________
“I would like to share my story, in order
to highlight the harm that I believe is caused by SSRI and SNRI antidepressants.
In 2008, I suffered the horrendous experience of a depressive psychosis. It was
diagnosed by psychiatry as ‘postnatal psychosis’. I now have a strong suspicion
that my psychosis was caused, or at least exacerbated, by SSRIs.
My first daughter was born in April
2008. I took citalopram at a steady dose for about 2 years prior to the birth
and throughout my pregnancy. In the days after she was born, I read that
sertraline was the safest SSRI to take while breastfeeding. I asked the GP
about it and she changed me from citalopram to sertraline. In the following
weeks I became very depressed. I was changed back to citalopram and the dose
was fairly rapidly increased.
In the weeks following this, I
became suicidally depressed and developed a florid depressive psychosis. I made
several suicide attempts and started to think I had a duty to kill my baby to
release her from the awful suffering that the world would cause her.
Fortunately for us all, before I acted on those thoughts, I was sectioned. I
continued on citalopram and olanzapine was added. I did not respond quickly to
the meds so was given ECT. I had a fairly rapid improvement following ECT and
was allowed home. However, after a few months my depressive psychosis returned.
I was changed to venlafaxine and quetiapine and after 3 months the depressive
psychosis lifted and I remained well until two years after the birth of my
second daughter in 2012. I was advised to take quetiapine for some months after
this birth.
I remained well for two years;
however, following a period of stress and no longer on quetiapine, I had
another episode of depressive psychosis. I remained on venlafaxine but this
time quetiapine was not effective. My antipsychotic was changed to amisulpride
and after 3 months I recovered. I have remained on a low dose of amisulpride
and have not experienced psychosis since then. I appreciate that it is very
difficult to prove, but I now wonder about the possibility that I have a
sensitivity to SSRIs/SNRIs and that my episodes of psychosis were actually
caused by citalopram/venlafaxine and that the psychosis was only subdued by the
addition of an antipsychotic. I was told on a number of occasions by the
psychiatry team that my illness was ‘atypical.’ I do not remember any of the
psychiatry team ever mentioning the possibility that my psychosis may have been
caused/exacerbated by SSRIs—it was always attributed to an underlying illness,
be it ‘postnatal psychosis’ or ‘psychotic depression.’ This has led me to
wonder how many other cases of psychosis may be influenced by these drugs,
which is why I want to highlight the issue. If psychiatry is not considering
this possibility, this potential cause will not be being reported and it could
be going unnoticed, meaning it is possible that, like me, some people are
advised to continue on the drugs that precipitated their psychosis in the first
place, with further treatments being added to counteract the negative effects
of the SSRI/SNRI.
I would also like to highlight the
problems I have had attempting to withdraw from venlafaxine. In discussion with
my psychiatrist, I decided to come off venlafaxine in 2015, having been well
for over two years. My psychiatrist recommended a taper which I now believe was
way too fast -over several weeks. The withdrawal during those weeks was a truly
awful experience. For the whole period of withdrawal and several weeks
afterwards, I felt like I had a severe bout of the flu and a terrible hangover.
I had electric shock sensations in my head. It felt as if my brain was being
constantly irritated by a chemical. I felt agitated and intensely irritable. I
felt an intense burning sensation in my head, spine and esophagus. My body
ached all over. I had abdominal pain. I lost my senses of taste and smell. Then
approximately three months after stopping venlafaxine, I became depressed. I
completely lost my appetite and felt a physical sensation of my body and mind
being an empty shell, unlike anything I had ever experienced. I was admitted to
a psychiatric unit. My bowel stopped working. I was put back on venlafaxine and
after approximately four months I fairly suddenly started to feel better again.
The physical symptoms disappeared. The psychiatry team were convinced the whole
episode was caused by my underlying illness—’psychotic depression,’ because my
depression could not be controlled without venlafaxine. However, I always
suspected that what I experienced was a very bad case of withdrawal from
venlafaxine.
Recently I decided I would like to
try to withdraw from venlafaxine again, but this time much, much more slowly. I
found a Facebook group dedicated to venlafaxine withdrawal. It has
approximately 3800 members. Time and time again people report that they were
not warned about the difficulties that many people have withdrawing from
venlafaxine—indeed most medical professionals seem completely unaware of the
problem that so many of us experience. The recommended taper advised in the
group is a maximum of 10% of the dose at a time, with a hold of at least 30
days or until all withdrawal symptoms have resolved, before tapering again. For
many of us, particularly those of us who have been taking it for a number of
years, it would seem that to have the best chance of getting off venlafaxine
and staying well we must reduce the dose very gradually over years. There are
members of the group who, like me, came off much more quickly on the advice of
their psychiatrist/GP, did not reinstate the drug quickly enough and who have
suffered a protracted withdrawal over years, with a whole host of symptoms.
I can’t help but feel that if there
could be a much greater understanding of antidepressant withdrawal amongst
medical professionals, including revised guidelines for withdrawal in the
community, then more of us would receive the support we need to come off venlafaxine
and other psychiatric drugs, rather than suffering intense withdrawal symptoms
and being told that they are nothing to do with withdrawal but are the return
of our original illness. I find it very interesting in relation to my suspicion
that I experienced SSRI induced psychosis that, since reducing my venlafaxine
dose from 150mg to 100mg, my thoughts seem less distorted and obsessive, I have
less anxiety, my thinking is much clearer, I have more energy and I am much
less drowsy.”
—From Petition Ref BBBBBBBB
__________________________
“In 2011, my doctor diagnosed me with mild
depression and fibromyalgia pain, and against my better judgment, I started
taking Ciprelex. I was told it was the new latest antidepressant, and was told
there would be no withdrawals when coming off them. (I realize now my doctor
was just repeating what the drug rep told him, and what literature he had read
from the drug company. I’m sure he thought this was a new safer drug to use for
treating depression and fibromyalgia pain.)
Shortly after taking Ciprelex, I
noticed electrical shocks, and a burning sensation going through my brain and
body (to the point I was afraid to drive or operate machinery). I talked to my
doctor and was told this was my body getting used to the chemical change in my
body, and only a few experience this. I felt it wasn’t really helping me and my
dose was increased from 10mg to 20mg a day. This drug basically made me into a
functioning zombie; shortly after taking this drug, I found I could no longer function
and do my job as a consultant/mechanical engineer in the oil fields (17 years).
I used to be very good at organizing, producing reports, troubleshooting, and
staying calm in difficult situations, doing math in my head.
My life turned into a nightmare, I
started having very violent and gory dreams (which was very unusual for me) and
started having suicidal thoughts (again, unusual for me). I was having trouble
with my eyesight shortly after going on this drug, saw an optometrist, and was
told it was my age was catching up to me, but could not explain why I developed
‘night blindness.’ (Having read reports, I am now finding out a lot of people
on these drugs have developed ‘night blindness’ and other eye problems.) For
me, it was to the point where I would not drive at night, and still won’t. Some
of the littlest daily problems can get me overwhelmed very easily.
The list of side effects from this
drug for me was very severe and long. The scary thing about it is I didn’t
realize or understand that it was the drug doing this to me. I felt I was on
the outside looking in. Due to my behavior I could not hold down jobs, did not
get along with other coworkers, was actually let go from a job (for the first
time in my life) after being a longtime employee at other jobs, always getting
along with everyone. I became a recluse, and lost interest in a lot of daily
life activities; reading, playing music. I had to shut down a part-time
photography and custom picture framing business (which was my passion). I was
severely depressed, suicidal, physically sick, suffered severe episodes of
anxiety (which was unusual for me). I had severe ‘brain fog,’ insomnia, etc. I
felt I had spiritually died inside, and felt I was dying physically to the
point that I purchased a body bag. My ‘distorted’ thinking being if I died, or
committed suicide, I didn’t want to leave a mess for others to deal with; this
way, it would be contained.
After an unusual night of clarity, I
was reflecting on my life and how terrible it had gotten, I realized it
started, or had changed since taking Ciprelex (2.5 years). I knew I had to get
off of it. I talked to my doctor and told him I wanted to get off Ciprelex, and
he agreed and we started slowly weaning off the dosage. This turned into
another nightmare all in itself (it was just horrible) as withdrawal was very
severe. The doctor and pharmacist kept telling me it was just my body getting
used to the chemical change in my body, and it would only last 6 weeks (again
both repeating what the drug literature, and drug reps had told them). I had to
go back on a higher dose of Ciprelex, and try a slower weaning off which took 6
months, still with very severe side effects. (This sounds like withdrawal to
me, even though the drug companies said there would be no withdrawal).
I have now been off Ciprelex for six
years, and am still dealing with the side effects, and possible brain damage. I
ended up selling just about everything I owned, and moved to live with family
(who are still having difficulty in understanding what the hell happened to
me). I have seen other doctors, psychologists who say no, it’s not the
Ciprelex, as it will only stay in the body for 6 weeks. (When I hear this, I
know they have been indoctrinated by the pharmaceutical companies, as most doctors
do not have a clue what these drugs are capable of.) I still have not been able
to get back to work or function normally. Even after six years of being off
Ciprelex, I still get electrical shocks and brain zaps (as a lot of people try
to describe them), and I never had these effects until I started taking
Ciprelex. There is severe memory loss from the past five years, as many others
have experienced also. And just to list a few more side effects, dysphoria,
akathisia, PTSD, anhedonia; I have been in and out of emergency rooms, but most
doctors offer very little help, and do not know how to deal with this, a lot of
time making the situation life threating.
I could go on and on, as this is
just a little snapshot of what I, and many others are going through, and the
hell they are dealing with. We are not going crazy we just have been poisoned,
and trying to find out if the brain damage is permanent, or temporary?
I understand why people go back on
these drugs after trying to get off them. It’s horrible. I have since found a
new doctor who is aware of what’s going on with these drugs. These drugs can
stay in your system for a very long time as I, and others are finding out (not
the six-week period like we were told by the drug companies) and are proving to
be very damaging to the brain. In desperation when coming off Ciprelex, I went
and saw an addiction counselor, who told me antidepressants are becoming a
‘huge’ problem for them.
Yes, they are very, very addictive
and very damaging drugs. Having researched and talking with many others, I am
finding I am not an isolated and unusual case. Just one of the sites I’m a
member of on Facebook (and there are many of them), which includes almost 4000
people from all over (again, this is just from ONE site) are experiencing the
same problems I am, in one form or another, from taking these drugs. This
information needs to get out to more people. There are thousands suffering in
silence, and they’re not gone, or going crazy, they have been poisoned! I have
lost everything that was dear to me, my career, marriage, my house, my music,
my passions, my spirituality, my life savings. I could write more, but I think
you get part of the picture.”
—From Petition Ref FF
__________________________
“Over the past 12 years, I have been existing
in an Orwellian/Kafkaesque nightmare of psychiatric drugs, psychiatrists and
hospitals. It started when I was put on the antidepressant Cipralex in 2005
after a prolonged period of stress which culminated in me being in London on
the day of the 7/7 terrorist attacks. Despite only taking a couple of tablets,
I developed what I now know is a condition called akathisia—an intense state of
agitation. I stopped taking the tablets immediately, but after a month of
severe anxiety, being unable to eat or sleep, I was admitted to a private
psychiatric hospital where they prescribed me the antipsychotic olanzapine off
label (i.e. not approved for that use). Two days later, I was suicidal.
I had never ever been suicidal
before. Over the next 10 years I tried numerous times to kill myself:
overdoses, attempted drowning, strangulation, trying to throw myself under a
train, you name it. Over the next 10 years, I saw nine further psychiatrists
and in total I was put on 15 different drugs. They told me I had severe depressive
disorder. I was anxious, depressed, emotionally blunted, agoraphobic as well as
suicidal. Not one of these so called ‘medical experts’ recognized that I was
having a catastrophic reaction to the drugs. They just kept chopping and
changing the drugs, upping and lowering the doses, starting and stopping at the
drop of a hat. I was even offered electroconvulsive therapy, which I declined.
I didn’t fancy having my brain fried.
During 2017, I spent 10 months
withdrawing from the final two drugs venlafaxine and mirtazapine. This
combination has a nick-name—’California Rocket Fuel.’ You can imagine what that
was doing to my poor nervous system. At times I felt so ill I thought I was
going to die. Sometimes I have had to spend days on end in bed. Early last
year, my blood pressure was skyrocketing and I had to call the paramedics out
twice. I finished my last dose just before Christmas. Since then I have been
suffering from severe insomnia, skin rashes, gastrointestinal problems and
burning/aching sensations over the whole of my body. I have no idea when and if
this will ever go away. I have also been trying to lose some of the 50+ lbs. in
weight that I put on due to these drugs. I am quite likely to end up with type
1 insulin dependent diabetes after 10 years on olanzapine, as it is one of the
major effects of this drug.
I have lost my home, my kids, my
relationships, my physical health and I am completely traumatized. At one point
a year ago I was virtually destitute: homeless, broke, ill and terrified. I had
even been on the receiving end of mental abuse by my own family who just do not
seem to understand. I nearly got sectioned when a psychiatrist turned up where
I was staying, accompanied by two henchmen who threatened to put me in
hospital, back on olanzapine. I was absolutely terrified.
Once you are in the mental health
system, it is very hard to get out of it. I have managed it, but even then they
have damned me further by giving me another totally subjective label of
schizo-affective disorder. They have tried to put me on a further
antipsychotic, quetiapine which I have refused to take. So what have these
wonderful drugs done for me? Basically they have totally and utterly destroyed
my life. Am I angry? No, I am absolutely incandescent with rage. If you look at
the statistics produced by The Samaritans, you will find that despite
skyrocketing rates of antidepressant prescribing, suicide rates across the UK
have changed little over the past 30 years. An article on the website
AntiDepAware recently quoted NHS statistics from a Dundee Evening Telegraph
article which reported that between 2009 and 2015, 147 people took their own
lives in Dundee. In 2016, numbers reached 37—the highest annual figure for 21
years. More than 87% of these people were apparently taking antidepressant
medication. Rather makes a mockery of the idea that these drugs save lives,
doesn’t it?”
—From Petition Ref JJJJJJJ
__________________________
“I write my story only in hope that I can
save people from ever getting on an antidepressant and/or benzodiazepine. I am
a married 45 year old businesswoman with two beautiful children who are 13 and
15 years old. I have my Bachelor of Science degree in Human Services and
currently work as an Account Executive. Most recently, I was on Lexapro for 12
years. I actually think I had been on something else when I was pregnant, but I
honestly cannot remember due to the short-term memory loss these drugs have
caused.
I was originally prescribed Lexapro
for an eating disorder (bulimia) and well as OCD tendencies. The Lexapro gave
me insomnia so the doctor also put me on a sleeping pill called Lunesta. When I
switched over health insurances to Kaiser, the doctor told me they do not cover
Lunesta as it is too addicting and asked that I try another ‘sleeping pill’
called Klonopin. Little did I know Klonopin is worse than Xanax and that it was
extremely addicting. I was taking 2mg of Klonopin for over 2 years. I also
started gaining weight so the doctor also put me on another pill called
phentermine. I was on two doses of 37.5mg of phentermine daily for over six
years.
Meanwhile, I have never done drugs
my whole life nor barely even drink alcohol. When I found out all these drugs
were addicting, I got nervous so I started lowering my dose of all the pills
over a 10-week period (which I now know was way too fast). By June 1st, 2016, I
was off all the drugs. My initial withdrawals were not so bad...then bam came
the third month and ALL hell broke loose! I literally had almost every
withdrawal symptom possible and they only got worse as the days went on. I was
like a complete vegetable; I couldn’t see well, hear well, I was confused, had
a hard time comprehending simple things, felt out of my body, racing thoughts,
crying spells, mood swings, sweats, cold chills, flu-like symptoms, nightmares,
felt depersonalized, dizzy, disoriented, diarrhea every day, no appetite,
sensitive to light, losing my hair...and the list goes on and on. I literally
felt like I was living in hell on earth.
As the days turned into weeks then months,
things only got worse. I ended up with so much anxiety and depression like I
have never experienced before. Then the insomnia kicked in so bad I ended up
not sleeping for three straight weeks which made me manic. I was pacing around
my house like a crazy woman and I couldn’t even sit still. My heart was
pounding out of my chest and I literally felt like I had become completely
mentally ill. By the sixth month, I became extremely suicidal and tried to take
my life by hanging myself. I had/have no recollection of this event as I
literally became that mentally ill. I was placed on a 5150 and put in a mental
ward for 10 days. It was literally the worst experience of my life.
In the hospital, they tried to drug
me up again. I was given Luvox, Zyprexa (which I refused to take) and Xanax
five times per day. The doctor would not even listen to my story nor lend me
five minutes of his time. In the hospital, I was still completely out of it and
couldn’t even sleep. I felt like a complete zombie. After I was released, I was
forced to move in with my 75 year old mother for a month as I couldn’t even
care for myself nor let my children see me in the condition I was in. I then
began to have an allergic reaction to the Luvox, so I slowly cross tapered over
to 10mg of Prozac and got back on a low dose of Klonopin.
As of today, I am only on 10mg of
Prozac and thankfully off the Klonopin and phentermine! I’ve been off the
Lexapro and phentermine for 19 months now and the Klonopin for 8 months but am
still feeling weird. It’s been 14 months since I was hospitalized and although
I am much better, I still don’t feel completely like myself. I am back to work
full-time but I’m not sure if I’m still going through withdrawals from all the
previous meds or if it’s side effects from the Prozac. As of today, I am still
losing my hair and have to wear a wig full time because of all the hair loss. I
was recently diagnosed with Androgenic Alopecia related to this situation. My
memory and vision are still horrible, but thankfully are slowly starting to get
better. I still have trouble sleeping and am dizzy at times as well.
I feel flat, with no happiness or
joy. I never want to do things and nothing really bothers me now. I am forcing
myself to get out of the house and do things with my family and friends. Since
this nightmare of an experience happened, this is all I think about. I
absolutely hate that I’m still on this poison, but honestly believe the only
reason I got better was because I went back on a medication. I honestly believe
I would still be sick/mentally ill had I stayed off everything and that is
what’s so traumatizing. I am scared to death to start my taper from Prozac in
fear of going through withdrawals again. My plan is to start a slow three-year
taper in another four months or so. If I successfully complete it, I will
definitely be making my story public in hopes to educate people on these
poisons!”
—From Petition Ref GGGGG
CONCLUSION
T |
AKING OR NOT taking
antidepressants is an individual’s choice. Being informed about the
evidence-based risks and benefits of antidepressants is an individual’s right.
Encouraging each other to question and learn about our options for treatment is
fundamental if we are to change the way we think about how we treat our “mental
health”. We need to wake up to the fact the current way we choose to cope with
the more difficult times in our lives is guided by neither evidence-based
science nor best practice.
This book has not been about
politics or “Big Pharma bashing” it has been about helping us make informed
choices about antidepressants and changing how we think about and talk about
coping with the difficult times in our lives.
Dainus Pūras believes we need to
address the social determinants of mental health and looks at inequalities in
daily life and social exclusion as major problems. “The urgent need for a shift
in approach should prioritize policy innovation at the population level,
targeting social determinants and abandon the predominant medical model that
seeks to cure individuals by targeting ‘disorders’. The crisis in mental health
should be managed not as a crisis of individual conditions, but as a crisis of
social obstacles which hinders individual rights. Mental health policies should
address the ‘power imbalance’ rather than the chemical imbalance.”240
This book has revealed some of the
obstacles hindering our individual rights to safe and effective treatment,
while acknowledging the wider context. Reforms in mental health laws, policies,
and practices are urgently needed as we become increasingly all too aware of
the unquantifiable “crisis of individual conditions” which needs to urgently be
addressed.
The power imbalance of our mental
health system has left us open to our inabilities to cope with life being
commercially and politically exploited. The pharmaceutical industry and
psychiatry have capitalized on the fact we believe and accept antidepressants
and other medications are a safe and effective answer to our problems. It has
somehow become acceptable for governments to fail to acknowledge and address
the social determinants affecting our lives. They have made us believe it is
our fault and not theirs.
This biomedical approach to mental
health, that mental disorders are brain diseases and that any medication-based
treatment targets the abnormalities involved in the brain, has dominated the
American Health Care system for over thirty years, since the introduction
Prozac. The most powerful voices such as the National Alliance on Mental
Illness (NAMI) and Mental Health America (MHA) promote mental health as being
just like physical health, diseases and illness. The language is that of
psychiatry with the tone of the smiling assassin. The MHA tag #B4Stage4, is a
comparison to cancer or other physical disease treatment. There is an emphasis
to “Get Screened” and “Identify the underlying illness.”241
The National Alliance on Mental
Illness (NAMI) proudly declares it receives generous support from numerous
partners including Pfizer, Teva, Bristol Myers Squibb, Janssen, Eli Lilly and
Lundbeck. It openly collaborates with the American Psychiatric Association. In
2009, the New York Times revealed, “A majority of the donations made to the
National Alliance on Mental Illness, one of the nation’s most influential
disease advocacy groups, have come from drug makers in recent years, according
to Congressional investigators.” “Drug makers are natural allies in these
pursuits since cures may come out of corporate laboratories and the industry’s
money can help finance public service campaigns and fund-raising dinners. But
industry critics have long derided some patient organizations as little more
than front groups devoted to lobbying on issues that affect industry profits,
and few have come under more scrutiny for industry ties than the mental health
alliance.”242
It all adds up to the powerful
promotion of a medical model of mental health disguised as advocacy. They
subtly communicate mental disorders are brain diseases and the model they use
tells us we need drugs to target our brain abnormalities and to reverse an
underlying disease. In her article in the Journal of Bioethical Inquiry, Sharon
Batt, a bioethicist from Dalhousie University, Canada, sums up the situation:
“Accepting industry money would result in vulnerable patients being susceptible
to the parroting of certain marketing messages that distorted scientific
evidence, with the potential to cause needless suffering, misplaced hope,
premature deaths, and misspent funds.”243
This bombardment of mental health
messages isn’t keeping us healthy. It is being strategically used by the
powerful to avoid responsibility. It enables governments to shy away from
dealing with the social determinants of our stress, anxiety and unhappiness. We
live with poverty, loneliness, homelessness, abuse, unemployment and the many
other social and environmental factors causing our distress, but we are told it
is all about our “mental health”. They tell us the problem is “our” mental health
and “we” need to fix it. It is our mental health that is our problem, our
illness or condition. It is a clever avoidance strategy to keep our attention
away from the investments needed in society to provide the resources to enable
us to live happy and healthy lives. We need psychosocial solutions, and we need
to realize it is life that is our problem and not the chemicals in our brain.
Our social problems have in turn conveniently become medical ones and it makes
life easier and more profitable for those at the top.
The mental health monster, born with
Prozac in the late 1980s, is an invasive creature trampling every aspect of
society in the developed world with no intention of stopping there. New markets
are in sight and the untreated and seemingly neglected nations will soon be the
focus for the continuing growth of pharmaceutical psychotropic interventions.
The fastest growing market, according to the Global Antidepressants Market
research report 2019244,
is Asia Pacific. “Asia Pacific is the fastest growing region for
antidepressants and portrays huge potential for growth in the future due to an
increasing prevalence of psychiatric disorders and rapid economic growth in
this region.” The most naturally resilient nations in the world are the next
antidepressant target market.
The COVID-19 pandemic has created
somewhat hysterical fear and talk of worldwide “mental illness.” Whilst some
speak of millions suffering PTSD or Depressive Disorders, others such as Dr.
Lucy Johnstone have taken a somewhat more realistic view of our situation.
“Surviving the pandemic, as most of us will, is only the start of it. However,
we must not be tempted back into a medical narrative, even though the aftermath
will probably be as bad, if not worse. Healthcare staff may be deeply shaken by
the suffering they saw, but we don’t have to call it an outbreak of ‘PTSD’.
People who have lost their jobs are likely to feel desperate, but we don’t have
to describe this as ‘clinical depression’ and prescribe drugs for it. The
economic recession that will follow the pandemic may lead to as many suicides
as austerity measures did, but we don’t have to say that ‘mental illness’
caused these deaths. The drug companies must be rubbing their hands at the
prospect of all these new customers. We can come out of this crisis in a better
state than before by staying connected with our feelings and the urgent threats
that have led to them and taking collective action to deal with the root causes.”245
At a time when there is talk of a
mental health epidemic, there has never been a more appropriate time to
question the medicalizing of our emotional distress. Mental illness is not a
disease and therefore not really an epidemic, it never was and never will be,
but unless we challenge the current mental health narrative, unless we educate
ourselves and learn about the powerful drugs we take, we will see more
suffering, illness and deaths.246
There has perhaps never been a better time for change.
Dainius Pūras talks of existing
alternatives to our current mental health system and the quiet revolution he
sees happening: “Such alternative practices with transformative potential have
been in existence for decades, with many shown to be effective. They take many
shapes and forms, from the commendable global work of WHO with its Quality
Rights initiative on improving the quality of mental health care and services,
to systems-level community health reforms in Brazil and Italy, to highly
localized innovations in different resource settings around the world, such as
Soteria House, Open Dialogue, peer-respite centers, medication-free wards. A
quiet revolution has been occurring in neighborhoods and communities worldwide.
At the root of these alternatives is a deep commitment to human rights, dignity
and non-coercive practices, all of which remain an elusive challenge in
traditional mental health systems too heavily reliant on a biomedical
paradigm.”247
There is growing awareness of the
need for that “paradigm shift in mental health” but as Dainius Pūras states,
“What that shift looks like in practice is a matter of much debate.” Whilst
governments around the world debate, medics remain willfully blind and charities
secure their funding, the change has to start with us as individuals, as
advocates and as informed patients. The fact that we know a doctor’s
appointment is often the start of a lifelong journey as a psychiatric patient
with a stigmatizing lifelong condition and dependence on psychiatric medication
means the shift starts by us questioning the overuse of antidepressants and
looking at alternative ways to support and care for each other. It starts by
becoming more knowledgeable, reclaiming some control and power over our own
healthcare and by taking responsibility to educate ourselves to the best of our
ability. It starts by understanding antidepressants are not the easy and quick
fix their makers and doctors say they are. It starts with the acceptance we
might be doing more harm than good by defining ourselves using mental health
labels and diagnoses. Life is difficult and we have all probably faced some
degree of trauma, stress and unhappiness in our life. We all have unmet needs
or times when life becomes too challenging and it is time to accept it is
mostly about social causes and not biological ones.
Prescribed drugs associated with
dependence and withdrawal have been described as “a significant public health
issue, one that is central to doctors’ clinical role, and one that the medical
profession has a clear responsibility to help address.”248 This is true throughout the
developed world. The following actions and considerations are amongst those
needed to prevent more overprescribing, harm and dependence.
Prescribing guidelines must be
adhered to and antidepressants should not be first-line treatment. Doctors
should recommend watchful waiting where appropriate. If we choose to take
antidepressants, we should be advised to take them for the shortest time
possible and long-term antidepressant use should be discouraged. We should be
reviewed frequently. Off-label prescribing of antidepressants should be avoided
where possible.
We need informed consent for
antidepressant treatment. This means we understand why, based on our diagnosis,
the treatment is being offered and we are aware of the benefits and risks. Only
then should we agree to the treatment. Informed consent is our medical right.
There is a need for better education
of medical professionals about the dangers of antidepressants including the
potential for dependence. We urgently need evidence-based withdrawal protocols.
The developed world must address the issue of antidepressant deprescribing and
withdrawal as a matter of urgency. The FDA and APA need to update guidelines on
antidepressant withdrawal.
Prescribing antidepressants to
children and young people should be questioned. Governments, medics and other
mental health organizations need to recognize antidepressant-induced suicide as
a leading cause, particularly amongst the young. Everyone must learn about
akathisia.
We urgently need support services
for those harmed by or dependent on antidepressants. There is currently little
support available for those of us withdrawing from antidepressants. The medical
profession must stop misdiagnosing withdrawal as relapse and unnecessarily
increasing medications. We need to question why we need to turn to unregulated
peer-led services for help.
We need investment in psychosocial
interventions as first-line treatment, and these should be available at a
community level to everyone who is experiencing mental health issues. We need
to question whether or not our human needs can really be met by psychotropic
drugs.
The FDA advises, “Be an active
member of your health care team. By taking time to learn about the possible
side effects of a drug and working with your health care provider and
pharmacist, you will be better prepared to reduce your chance of experiencing a
side effect or coping with any side effect that you may experience.”249
This is very good advice, but we need to be more than an active member of our
healthcare team. We need to become informed, educated and we must share our
knowledge if we are to reduce the role and impact antidepressants have on our
lives and society.
As governments and the medical
profession continue to underestimate and ignore the problem, we find ourselves
in a situation where, for the current time at least, it is down to the power of
patient experience and those of us willing to question the status quo to make
change happen. It is suggested we start to think about “what is happening with
you?” rather than “what is wrong with you?” It is a good question to ask as it
often highlights the true sources of our distress. It is a simple question that
could prevent us becoming part of the medicalized mental health system and
taking unnecessary medication. Whatever our age, whatever adverse experiences
or trauma we might have encountered in our life, we all have a right to reach
our full potential and thrive. We all have a right to live a label free and
unmedicated life if that is what we choose. We all have a right to question if
doctor always knows best when it comes to the “wicked” problem of
antidepressants.
THE RESOURCE GUIDE
GENERAL DRUG INFORMATION
SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIs) |
|
GENERICS |
BRAND NAMES* |
Citalopram |
Celexa, Cipramil |
Escitalopram |
Cipralex, Lexapro |
Fluoxetine |
Prozac, Sarafem |
Fluvoxamine |
Luvox, Faverin |
Paroxetine |
Paxil, Seroxat |
Sertraline |
Zoloft, Lustral |
SEROTONIN NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIs) |
|
GENERICS |
BRAND NAMES* |
Desvenlafaxine |
Pristiq |
Duloxetine |
Cymbalta |
Levomilnacipran |
Fetzima |
Milnacipran |
Ixel, Savella |
Venlafaxine |
Effexor |
*These drugs have many different brand names throughout
the world. Medications might be available in tablet, capsule, or liquid form. |
|
Antidepressant |
Approximate Half-Life (Hours) |
Citalopram |
36 |
Desvenlafaxine |
11 |
Duloxetine |
30 |
Escitalopram |
8-17 |
Fluoxetine |
96-144 |
Fluvoxamine |
24 |
Levomilnacipran |
12 |
Milnacipran |
8 |
Paroxetine |
17-22 |
Sertraline |
22-36 |
Venlafaxine |
4-7 |
Medications might be available in tablet, capsule, or
liquid form. |
Where can you go to learn more about
prescription drugs and over-the-counter medicines, including side effects,
dosage, special precautions, interactions etc.?
·
www.medlineplus.gov
·
www.drugs.com
·
www.pimsplus.org
·
www.fda.gov/drugs/resources-you-drugs/
drug-information-consumers
·
www.medicinenet.com
·
www.dailymed.nlm.nih.gov
·
www.rxisk.org
USEFUL RESOURCES
Inner Compass Initiative/The Withdrawal Project/Connect
Inner Compass Initiative, The Withdrawal
Project, ICI Connect, and TWP Connect are web-based online information-sharing
and connecting platforms which seek to provide opportunities for likeminded
people to find each other, and to facilitate the sharing of information that
improves the general public’s understanding of psychiatric drug withdrawal and
of “mental health” diagnoses and treatments generally. Any and all information,
materials, and content posted on the Website is provided for general
educational and informational purposes only. Unless expressly stated otherwise,
the authors, bloggers, and/or editors of the Website are laypeople who have
direct personal experience taking, reducing, or tapering off psychiatric
medication and/or supporting someone else who has taken, reduced, or tapered off
psychiatric medication.
The Withdrawal Project is an
information resource designed to help people empower themselves to make more
meaningfully informed choices—aligned with their personal desires and
needs—regarding taking, reducing, and coming off psychiatric drugs. TWP’s
website includes a free, comprehensive, self-directed Companion Guide to
Psychiatric Drug Withdrawal aimed at helping people learn and make decisions
about the most risk-minimizing ways to prepare for tapering off and more
responsibly taper off antidepressants, benzodiazepines, stimulants,
antipsychotics, mood stabilizers, Z-drugs and other psychiatric drugs, along
with coping techniques for dealing with common withdrawal symptoms.
ICI Connect
ICI Connect is a simple, free online platform
that is designed to help people who are asking questions or thinking critically
about the mental health system find and connect with each other in person.
After creating basic profiles, members can search by location and/or interest
for other members who live nearby in order to connect, share information, spark
new friendships or collaborations, provide mutual support or advocacy, organize
public learning events or groups, set up crisis networks, or begin to build
grassroots community alternatives to the mental health system. Our members are
generally people who’ve experienced or witnessed some of the misleading,
coercive or harmful aspects of our current mental health system—we’re part of a
rapidly growing segment of society that has become passionate about developing
alternative approaches and building more mutually supportive and socially just
communities beyond the mental health system.
Surviving Antidepressants
www.survivingantidepressants.org
SurvivingAntidepressants.org is a site for
peer support, documentation, and education regarding tapering and withdrawal
syndrome from psychiatric drugs, including antidepressants.
Withdrawal syndrome may occur after
you stop taking a psychiatric medication and can last weeks, months, or years.
While some people may be able to quickly stop taking these medications without
serious symptoms, severe withdrawal syndrome can happen to anyone.
Tapering off the medication is the
only known way to reduce the risk of withdrawal syndrome. Don’t risk the
integrity of your nervous system; if not in an emergency, do not suddenly stop
taking any psychiatric medication.
Harm Reduction Guide to Coming Off Psychiatric
Drugs/Will Hall
willhall.net
The Fireweed Collective/Icarus Project and
Freedom Center’s 52-page illustrated guide gathers the best information and
most valuable lessons from more than a decade of peer support community mutual
aid. This free guide is used internationally by individuals, families,
professionals, and organizations, and is available in more than 14
translations.
RxISK
RxISK is a free, independent drug safety
website to help you weigh the benefits of any medication against its potential
dangers. In its Antidepressant Guide, it includes information about side
effects of antidepressants, stopping antidepressants, notes on antidepressant
withdrawal to take to your therapist, and Post-SSRI Sexual Dysfunction (PSSD).
Psychiatric Drug Facts with Dr. Peter Breggin MD
Dr. Peter Breggin’s Antidepressant Drug
Resource & Information Center For Prescribers, Scientists, Professionals,
Patients and their Families.
Mad in America
Mad in America’s mission is to serve as a
catalyst for rethinking psychiatric care in the United States (and abroad). We
believe that the current drug-based paradigm of care has failed our society,
and that scientific research, as well as the lived experience of those who have
been diagnosed with a psychiatric disorder, calls for profound change.
MIA’s withdrawal pages are meant to
provide resources, research findings, and personal stories relevant to making
informed choices about withdrawing from psychiatric drugs. In addition to the
general information on this page, there are links to withdrawal information.
Mad in the UK
MITUK’s mission is to serve as a catalyst
for fundamentally re-thinking theory and practice in the field of mental health
in the UK, and promoting positive change. We believe that the current
diagnostically-based paradigm of care has comprehensively failed, and that the
future lies in non-medical alternatives which explicitly acknowledge the causal
role of social and relational conflicts, abuses, adversities and injustices.
The Council for Evidence-based Psychiatry
CEP exists to communicate evidence of the
potentially harmful effects of psychiatric drugs to the people and institutions
in the UK that can make a difference. The scientific record clearly shows that
psychiatric medications, portrayed as safe and effective by areas of the
medical profession, often lead to worse outcomes for many patients,
particularly when taken long term. Our members include psychiatrists,
academics, withdrawal support charities and others who are concerned about the
prevalence of the ‘medical model’ and the increasing numbers of prescriptions
for psychiatric drugs being given to both adults and children.
Let’s Talk Withdrawal
Psychotropic prescription drugs (such as
antidepressants, antipsychotics and anxiolytic medications) are often very
difficult to stop taking. Users who have come to the end of treatment and wish
to stop can suffer debilitating withdrawal symptoms, even when following their
doctor’s advice. In some cases, these withdrawal symptoms can be so severe that
they prevent the user from stopping their medication. This site exists to
describe the problem, provide interviews with people who have lived experience
and campaign for change.
Medicating Normal
The film acknowledges that psychiatric
drugs do help alleviate suffering for a segment of those who take them.
However, it is estimated that of the 1 in 5 Americans taking such meds, 30% to
35% are gravely harmed by the very treatment meant to help them. Medicating
Normal focuses on the predicament of this group—individuals facing trauma and
stress who are drugged needlessly and made sicker as a result. Interviews with
experts in the film reveal that significant numbers of these people will get
better over time without medication. The website includes information about
withdrawal and alternatives.
MIND
www.mind.org.uk/media/8453/coming-off-medication-2021-pdf-version.pdf
Coming Off Psychiatric Drugs. Many people
would like to stop their psychiatric medication but coming off can be difficult.
This booklet is for people who are thinking about coming off their medication
and for friends, family and others who want to support them.” Free to download.
Robert Whitaker Books
Robert Whitaker has won numerous awards as
a journalist covering medicine and science, including the George Polk Award for
Medical Writing and a National Association for Science Writers’ Award for best
magazine article. In 1998, he co-wrote a series on psychiatric research for the
Boston Globe that was a finalist for the Pulitzer Prize for Public Service.
Anatomy of an Epidemic won the 2010 Investigative Reporters and Editors book
aware for best investigative journalism. He is also the publisher and founder
of Madinamerica.com, a critical psychiatry webzine.
Fiddaman Blog
Author of The Evidence, However, is Clear:
The Seroxat Scandal. Researching drug company and regulatory malfeasance for
over 16 years. Humanist, humorist.
Akathisia Alliance for Education and Research
The “Akathisia Alliance for Education and
Research” is a nonprofit organization formed by people who have experienced it.
Our group includes biochemists, psychologists, nurses, attorneys, business
owners, and others who have survived akathisia, suicidality, and devastating
personal losses due, in part, to a lack of awareness by medical professionals.
We have come together from all walks of life to battle these things we all have
in common, so we can help prevent them from happening to others.
MISSD
MISSD is pleased to now offer Akathisia
101. The free, online one-hour continuing education course is open to all who
want to better understand, identify and respond to akathisia. Akathisia 101 is
approved by the National Association of Social Workers for 1 continuing
education contact hour. Healthcare and crisis teams, patients, therapists,
caregivers, doctors, first-responders, drug safety advocates and
educators—everyone can benefit from akathisia awareness. Let’s make Akathisia a
household word.”
Bloom in Wellness
Bloom in Wellness is a soothing and
uplifting website that was created for anyone wanting a quiet retreat to focus
on healing and recovery, and on living one’s best life despite challenges. This
is a tranquil, private space for you to renew hope and regain your equilibrium
if coping with whatever you are facing is difficult and motivation to persevere
is waning. It offers a Q and A room where members can post questions at any
time, an archive of webinars, videos, meditations, mindfulness exercises,
reflections, 101 gentle reminders, daily challenges and coping tips, all to
encourage you.
This site presents you with an
experiential immersion in responsible, inspiring, encouraging and supportive
content. Over time you will build a resource toolbox that you can access when
needed, and this will help you to keep your perspective on healing and guide
you on in your recovery journey.
The International Antidepressant Withdrawal Project
www.antidepressantwithdrawal.info
The International Antidepressant Project
helps people make a fully informed decision about taking antidepressants;
discusses dangers connected with taking them; advises on tapering methods; and
supports through withdrawal and recovery.
We offer information and discussion
on alternative healing methods; the latest media on medications, Big Pharma,
neuroscience, and health; our own educational and informational videos;
spiritual and psychic matters; music; humor; and uplifting stories from the
news.
International Coalition for Drug Awareness
“Educating about the dangers of Rx
Medications.” Includes an Mp3 download: “How to withdraw safely from
antidepressant medications (Details safe and successful withdrawal from
antidepressants, benzodiazepines, or any other type of mind-altering
medications).
The International Society for Ethical Psychology and
Psychiatry, Inc. (ISEPP)
A non-profit volunteer organization of
mental health professionals, physicians, educators, ex-patients and survivors
of the mental health system, and their families. We are not affiliated with any
political or religious group.
Our mission is to use the standards
of scientific inquiry and critical reasoning to address the ethics of
psychology and psychiatry. We strive to educate the public about the nature of
“mental illness”, the de-humanizing and coercive aspects of many forms of
mental health treatment, and the alternative humane ways of helping people who
struggle with very difficult life issues.
We believe this is essential since
one of the most cherished principles of the mental profession is “informed
consent”. That means you should be fully and honestly informed about the
problems you are experiencing, and the full risks and benefits of any
treatment, before making truly voluntary decisions about your care. Our goal is
to fully inform you.
The International Institute for Psychiatric Drug
Withdrawal
We support the process of reducing and
withdrawing from psychiatric drugs through practice, research and training.
AntiDepAware
Promoting the awareness of the dangers of
antidepressants. This website, which I began in 2013, includes links to reports
of inquests held in England and Wales since 2003. Most of these were found in
the online archives of local and national newspapers. It must be noted that
these lists are far from exhaustive but, even so, contain summaries of more
than 7500 reports on self-inflicted deaths, all of which are related to use of
antidepressants. There are also many articles, most of which I have written
myself, based on what I have discovered during my research. My motivation in
embarking on this site has been to offer some understanding to the grieving
families who are invariably left a legacy of unanswered questions and “if
only’s”, along with misplaced guilt and the memory of horrific loss. Perhaps
this website will help answer some of their questions.
SSRI Stories: Antidepressant Nightmares
SSRI Stories is a collection of over 7,000
stories most of which were published newspapers or scientific journals. In
these stories, prescription antidepressant medications are mentioned. Common to
all of them is the possibility—sometimes the near certainty—that the drugs
caused or were a contributing factor to some negative outcome: suicide,
violence, serious physical problems, bad withdrawal reactions, personality
change leading to loss of reputation and relationships, etc.
Institute for Safe Medication Practices
Educates the healthcare community and
consumers about safe medication practices. Includes a mix of resources for free
and at a cost.
TaperMD
Leading-Edge Medication Therapy Management
and Drug Review Tool TaperMD is a clinically-proven tool—integrating healthcare
information for healthcare providers to optimize care decisions and save time.
The patient focused dashboard streamlines visual evidence and review tools to
avoid information overload.
Our vision is of a medical system
where explicit interventions for reducing the burden of treatment are part of
routine preventive care— just like immunization and screening.
TaperMD was originally developed by
Data Based Medicine Americas Ltd., in conjunction with the Department of Family
Medicine at McMaster University, to help reduce the medication burden in
seniors. We have used it in various research studies to validate and improve
the system, and now we are offering it for broader clinical use beginning with
approved beta testers. For more information on the McMaster Taper project click
here.
With TaperMD, patients and their
health care professionals have a simple but powerful tool to begin a meaningful
conversation by discussing questions such as:
·
Do I still need all of my medications or
can some of them be tapered or stopped?
·
Do my medications reflect my priorities for
care?
·
Can this effect that I am experiencing be
caused by a medication?
·
Can my pill regimen be simplified?
·
Are there strategies that don’t use drugs
for my condition?
Open Dialogue
Open Dialogue is an innovative,
network-based approach to psychiatric care that was first developed in the
1980s by a multidisciplinary team at Keropudas Hospital in Tornio, Finland. It
is a new approach to mental healthcare. In contrast to standard treatments for
early psychosis and other crises, Open Dialogue emphasizes listening and
understanding and engages the social network from the very beginning—rather
than relying solely on medication and hospitalization. It comprises both a way
of organizing a treatment system and a form of therapeutic conversation, or
Dialogic Practice, within that system.
Everything Matters—Beyond Meds
Monica Cassani documents and shares many
natural methods of selfcare for finding and sustaining health in body, mind and
spirit and deals with wider issues in the socio/political and spiritual realms
as they pertain to mental health and human rights issues surrounding
psychiatry.”
Warfighter Advance
Warfighter Advance changes the trajectory
of the warfighter’s post-deployment life, so that rather than an existence
characterized by an endless cycle of mental illness diagnoses, medications,
medical appointments and disappointments, the warfighter has a life
characterized by pride, productivity, healthy relationships, continued service,
and advocacy for the same outcomes for their fellow service members.
A Disorder For Everyone
Challenging the culture of psychiatric
diagnosis. Exploring trauma informed alternatives. We need an altogether
different approach to emotional distress than slapping labels onto people that
have essentially been made up around a table!
Chaya Grossberg
“Med Free Solutions for a Med FREE Life”
Do you wish there was a magic pill to get
off psychiatric medication as quickly as easily as you got on? Do you long for
that alive, alert and connected feeling you once had in life?
Do concerns about how to get off
psychiatric medication negatively affect your life? Do you feel your doctors
inadequately provide the support you really need? You’re in the right place. I
have helped many successfully get off psychiatric medication, and reclaim their
energy, health, and life. And I can help YOU. I’m not a magic pill. But I can
help you see and clarify your purpose. I can help provide healthy and holistic
alternatives to help you get off psychiatric medication so you can have your
life back. Together we can map out the road back to freedom. I offer my story,
how I was able to get off psychiatric medication, and tried and true methods.
Emotional CPR
Emotional CPR (eCPR) is an educational
program designed to teach people to assist others through an emotional crisis
by three simple steps: C = Connecting P = emPowering, and R = Revitalizing.
The Connecting process of eCPR
involves deepening listening skills, practicing presence, and creating a sense
of safety for the person experiencing a crisis. The emPowering process helps
people better understand how to feel empowered themselves as well as to assist
others to feel more hopeful and engaged in life. In the Revitalizating process,
people re-engage in relationships with their loved ones or their support
system, and they resume or begin routines that support health and wellness
which reinforces the person’s sense of mastery and accomplishment, further
energizing the healing process.
eCPR is based on the principles
found to be shared by a number of support approaches: trauma-informed care,
counseling after disasters, peer support to avoid continuing emotional despair,
emotional intelligence, suicide prevention, and cultural attunement. It was
developed with input from a diverse cadre of recognized leaders from across the
U.S., who themselves have learned how to recover and grow from emotional
crises. They have wisdom by the grace of first-hand experience.”
Integrative Mental Health for You
·
Learn about effective alternatives to
psychiatric medications in online presentations Understand phenomena of
spiritual awakening
·
Find out how to manage spiritual crisis We
specialize in
·
Cultivating Spiritual Emergence
·
An Integrative Approach to Mental Health
·
Unique Courses and Continuing Ed credits
available for health care providers
The OLLIE Foundation
OLLIE is a charity dedicated to delivering
suicide awareness, intervention and prevention training by empowering
professionals and young adults in their own communities to lead suicide
prevention activities. It is widely accepted in society that with appropriate
support and education, suicide can be prevented.
We do this by:
·
Providing confidential help and advice to
young people and anyone worried about a young person
·
Helping others to prevent young suicide by
delivering a number of training programs
·
Campaigning and influencing national policy
Human Givens
Thousands of people around the world
recognize that the organizing ideas summed up in the phrase ‘human givens’ have
enormous, beneficial implications for education, mental health, social order
and the world of business, politics and diplomacy. The human givens approach
enables us to think more clearly about a wide range of social issues to do with
the running of society and the future and physical survival of our species,
including how we bring up children to live in a rapidly changing environment.
Compassionate Mental Health
www.compassionatementalhealth.co.uk
Compassionate Mental Health is working with
a network of people across the UK and internationally to transform mental
health services, and radically change the conversation around mental illness.
OUR VISION is of a world where more people recover after a serious mental
health crisis, and people have access to a range of compassionate services to
help develop positive mental health and wellbeing.
The Icarus Project
The Icarus Project envisions a new culture
and language that resonates with our actual experiences of ‘mental illness’
rather than trying to fit our lives into a conventional framework. We are a
network of people living with and/or affected by experiences that are commonly
diagnosed and labeled as psychiatric conditions. We believe these experiences
are mad gifts needing cultivation and care, rather than diseases or disorders.
By joining together as individuals and as a community, the intertwined threads
of madness, creativity, and collaboration can inspire hope and transformation
in an oppressive and damaged world.
Epidemic Answers
Unacceptable numbers of children are ill,
impaired, delayed and struggling while caregivers feel overwhelmed, misinformed,
and disem-powered in a culture and system that neither fully values their
inherent wisdom and authority nor respects the interdependence of human and
planetary health.
Our vision is a world where parents
and professionals are empowered with the knowledge, resources and support
essential to raising healthy and vibrant children in today’s world.
Our mission is to generate and share
essential knowledge, inspire innovation, and build community in order to
prevent and reverse children’s chronic health and developmental conditions so
they may thrive in today’s world.
UK Post SSRI Sexual Dysfunction Organization
We are an association for people in the UK
experiencing an iatrogenic (meaning caused by a medication or medical
treatment) disorder known commonly as Post-SSRI Sexual Dysfunction or Post
SSRI/SNRI Sexual Dysfunction. This disorder arises during or after the use of
SSRI (selective serotonin re-uptake inhibitor) and SNRI
(Serotonin-norepinephrine re-uptake inhibitor) antidepressants. Though
characterized by a reduction or removal of sexual functioning, common symptoms
also include emotional blunting, cognitive dysfunction, genital numbness and
other symptoms. The causes of PSSD are poorly understood and there are no known
reliable treatments. The disorder can arise from brief exposure to SSRIs or
SNRIs and can persist for months, years or indefinitely. Though recognized by
the European Medicines Agency, PSSD is not yet officially acknowledged by the Department
of Health, the NHS or NICE guidelines. The association and website exist to
bring together people in the UK suffering from this condition and advocate for
recognition, research and greater transparency within psychiatry concerning the
risks of antidepressants.
Antidepressant Risks: Helping People Understand the
Risks of Taking Antidepressants
The aims of this site are:
·
To share stories of people who have been
harmed by antidepressants and other depression medications. See Stolen Lives.
·
To make people aware of the side effects of
antidepressants and the difficulty of withdrawal.
·
To explain that adverse reactions to
antidepressants can cause suicide, violence and homicide.
·
To draw attention to the potentially life
threatening conditions of serotonin syndrome and akathisia.
We are a team of people with experience of
these drugs and with access to experts. We have come together to share our
knowledge and experience to help people understand the risks of taking
antidepressants.
Canada Post SSRI Sexual Dysfunction Organization
We are a group of Canadians experiencing an
iatrogenic (meaning caused by a medication or medical treatment) disorder known
commonly as Post-SSRI Sexual Dysfunction or Post SSRI/SNRI Sexual Dysfunction.
This disorder arises during or after the use of SSRI (selective serotonin
re-uptake inhibitor) and SNRI (Serotonin-norepinephrine re-uptake inhibitor)
antidepressants. Though characterized by a reduction or removal of sexual
functioning, common symptoms also include emotional blunting, cognitive
dysfunction, genital numbness and sleep disruption. The causes of PSSD are
poorly understood and there are no known reliable treatments. The disorder can
arise from brief exposure to SSRIs or SNRIs and can persist for months, years
or indefinitely. This page exists to bring together people in Canada suffering
from this condition and advocate for recognition, research and greater
transparency within psychiatry concerning the risks of antidepressants.
Critical Psychiatry Network
Critical psychiatry is a broad critique of
mainstream psychiatry that has emerged in recent years which challenges some of
psychiatry’s most deeply held assumptions. It mounts a scientific challenge to
claims about the nature and causes of mental disorder and the effects of
psychiatric interventions, and draws on philosophy, history, anthropology,
social science and mental health service users’ experiences. There is no
definitive ‘critical psychiatry position.’ It is a collection of critical
perspectives intended to produce a more reflective, skeptical and
patient-centered approach to the theory and practice of psychiatry.
Kim Witczak is a leading global drug safety
advocate and speaker with over 25 years professional experience in advertising
and marketing communications. She became involved in pharmaceutical drug safety
issues after the sudden death of her husband due to undisclosed drug side
effect of an antidepressant. Kim co-founded Woodymatters, a non-profit
dedicated to advocating for a stronger FDA and drug safety system. She
co-created and organized the international, multi-disciplinary conference
Selling Sickness: People Before Profits conference in Washington, D.C.
ADDITIONAL READING
A Mind of Your Own: The Truth About
Depression and How Women Can Heal Their Bodies to Reclaim Their Lives by Kelly
Brogan, MD with Kristin Loberg
A Straight-Talking Introduction to
Psychiatric Diagnosis by Lucy Johnstone
A Straight-Talking Introduction to
Psychiatric Drugs (Second Edition): The Truth About How They Work And How To
Come Off Them by Joanna Moncrieff
A Straight-Talking Introduction to Caring
for Someone with Mental Health Problems by Jen Kilyon and Theresa Smith
A Straight-Talking Introduction to
Children’s Mental Health Problems by Sami Timimi
A Straight-Talking Introduction to the
Causes of Mental Health Problems by John Read and Pete Sanders
ADHD Nation: Children, Doctors, Big Pharma,
and the Making of an American Epidemic by Alan Schwarz
Alternatives Beyond Psychiatry by Peter
Stastny and Peter Lehmann
Anatomy of an Epidemic: Magic Bullets,
Psychiatric Drugs, and the Astonishing Rise of Mental Illness in America by
Robert Whitaker
Being Old Is Different: Person-Centred Care
For Old People by Marlis Portner
Bottle of Lies: The Inside Story of the
Generic Drug Boom by Katherine Eban
Can Medicine Be Cured?: The Corruption of a
Profession by Seamus O’Mahony
Coming Off Psychiatric Drugs by Peter
Lehmann
Cracked: Why Psychiatry is Doing More Harm
Than Good by James Davies
Crazy Like Us: The Globalization of the
American Psyche by Ethan Watters
Deadly Medicines and Organized Crime by
Peter Gøtzsche
Depression Delusion by Dr. Terry Lynch
Drop The Disorder! Challenging The Culture
Of Psychiatric Diagnosis by Jo Watson
Emperor’s New Drugs: Exploding the
Antidepressant Myth by Irving Kirsch
Generic: The Unbranding of Modern Medicine
by Jeremy A. Greene
Guidance for Psychological Therapists:
Enabling Conversations with Clients Taking or Withdrawing From Prescribed
Psychiatric Drugs (www. prescribeddrug.info)
Harm Reduction Guide to Coming off
Psychiatric Drugs (Second Edition) by Will Hall Icarus Project and Freedom
Centre
Insane Medicine by Sami Timimi
Inside Out, Outside In: Transforming Mental
Health Practices by Lydia Sapouna, Harry Gijbels and Gary Sidley
It’s Not Always Depression: Working the
Change Triangle to Listen to the Body, Discover Core Emotions, and Connect to
Your Authentic Self by Hilary Jacobs Hendel and Diana Fosha
JCPCP The Journal of Critical Psycholgy,
Counselling and Psychotherapy, Volume 20, #4 Winter 2020, Special Edition:
Withdrawal from Prescribed Drugs
Lost Connections: Why You’re Depressed and
How to Find Hope by Johann Hari
Mad in America: Bad Science, Bad Medicine,
and the Enduring Mistreatment of the Mentally Ill by Robert Whitaker
Mad Medicine: Myths, Maxims and Mayhem in
the National Health Service by Dr Andrew Bamji
Mad Science: Psychiatric Coercion,
Diagnosis, and Drugs By Stuart A. Kirk, Tomi Gomory, and David Cohen
Madness Explained Psychosis and Human
Nature by Richard P. Bentall
Malcharist by Paul John Scott
Mental Health, Inc.: How Corruption, Lax
Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens by Art
Levine
Own Your Self: The Surprising Path beyond
Depression, Anxiety, and Fatigue to Reclaiming Your Authenticity, Vitality, and
Freedom by Kelly Brogan, MD
Psychiatric Drug Withdrawal: A Guide for
Prescribers, Therapists, Patients and their Families by Peter R. Breggin
Psychiatric Drugs Key Issues and Service
Users Perspectives by Jim Read
Psychiatry and Mental Health: A Guide for
Counsellors and Psychotherapists by Rachel Freeth
Psychiatry and The Business of Madness by
Bonnie Burstow
Psychiatry Under The Influence:
Institutional Corruption, Social Injury, and Prescriptions for Reform by Robert
Whitaker and Lisa Cosgrove
Saving Normal: An Insider’s Revolt Against
Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization
of Ordinary Life by Allen Frances, MD
Sedated: How Modern Capitalism Created Our
Mental Health Crisis by James Davies
The Antidepressant Solution: A Step by Step
Guide to Safely Overcoming Antidepressant Withdrawal, Dependence, and Addiction
by Joseph Glenmullen, MD
The Body Keeps the Score Brain, Mind, and
Body in the Healing of Trauma by Bessel Van Der Kolk, MD
The Patient Revolution: How We Can Heal the
Healthcare System by David Gilbert
Mental Health, Inc.: How Corruption, Lax
Oversight and Failed Reforms Endanger Our Most Vulnerable Citizens by Art
Levine
Own Your Self: The Surprising Path beyond
Depression, Anxiety, and Fatigue to Reclaiming Your Authenticity, Vitality, and
Freedom by Kelly Brogan, MD
Psychiatric Drug Withdrawal: A Guide for
Prescribers, Therapists, Patients and their Families by Peter R. Breggin
Psychiatry and Mental Health: A Guide for
Counsellors and Psychotherapists by Rachel Freeth
Psychiatry Under The Influence:
Institutional Corruption, Social Injury, and Prescriptions for Reform by Robert
Whitaker and Lisa Cosgrove
Saving Normal: An Insider’s Revolt Against
Out-of-Control Psychiatric Diagnosis, DSM-5, Big Pharma, and the Medicalization
of Ordinary Life by Allen Frances, MD
Sedated: How Modern Capitalism Created Our
Mental Health Crisis by James Davies
The Body Keeps the Score Brain, Mind, and
Body in the Healing of Trauma by Bessel Van Der Kolk, MD
The Pill That Steals Lives: One Woman’s
Terrifying Journey to Discover the Truth about Antidepressants by Katinka
Blackford Newman
The Truth about the Drug Companies: How
They Deceive Us and What to Do About It by Marsha Angell, MD
The Zyprexa Papers by Jim Gottstein
They Say You’re Crazy: How The World’s Most
Powerful Psychiatrists Decide Who’s Normal by Paula Caplan
Toxic Psychiatry: Why Therapy, Empathy and
Love Must Replace the Drugs, Electroshock, and Biochemical Theories of the “New
Psychiatry” by Peter Breggin
When the Body Says No: The Cost of Hidden
Stress by Gabor Maté, MD
Your Drug May Be Your Problem: How and Why
to Stop Taking Psychiatric Medications by Peter Breggin and David Cohen
KEY ARTICLES, INFORMATION
AND RESEARCH
Informed Consent and Prescribing
www.fda.gov/regulatory-information/search-fda-guidance-documents/informed-consent
apa.org/monitor/2012/06/prescribing
theinnercompass.org/blog
www.gmc-uk.org/ethical-guidance/ethical-guidance-for-doctors/decision-making-and-consent
www.counterpunch.org/2014/05/14/psychiatrys-manufacture-of-consent
bigthink.com/surprising-science/antidepressant-effects
popularresistance.org/psychiatrys-manufacture-of-consent-the-antidepressant-explosion
doi.org/10.1136/bmj.n895
bjgplife.com/2021/04/20/the-four-research-papers-i-wish-my-doctor-had-read-before-prescribing-an-antidepressant/?fbclid=IwAR3x-h79cEDzg2viPUYXVmvzHcUhkMkcjhX8qmrDlHyjaTadbsAlPYv_BFI
Withdrawal/Tapering
Lewis, S. (2021). The four research papers
I wish my doctor had read before prescribing an antidepressant. British Journal of Medical Practice. DOI:
doi.org/10.3399/bjgp21X716321
www.madinamerica.com/2021/07/223158
www.cochranelibrary.com/cdsr/doi/10.1002/l4651858.CD013495.pub2/full
withdrawal.theinnercompass.org/taper/determine-how-taper-friendly-your-drug
withdrawal.theinnercompass.org/learn/psychiatric-drug-taper-rates-review-and-discussion
withdrawal.theinnercompass.org/page/withdrawal-symptoms-zrxisk.org/guide-stopping-antidepressants
survivingantidepressants.org/forum/14-tapering
survivingantidepressants.org/topic/9167-how-to-calculate-dosages-and-dilutions-spreadsheets-and-calculators
nytimes.com/2019/03/05/health/depression-withdrawal-drugs.xhtml
psychologytoday.com/us/blog/sideeffects/201810/antidepressant-withdrawal-said-affect-millions
rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants
pharmaceutical-journal.com/news-and-analysis/news/national-guidance-for-antidepressant-withdrawal-too-fast-for-some-patients-says-rcpsych/20206614.article?firstPass=false
thelancet.com/article/S2215-0366(19)30032-X/fulltext
rcpsych.ac.uk/mental-health/treatments-and-wellbeing/stopping-antidepressants
apa.org/monitor/2020/04/stop-antidepressants
pubmed.ncbi.nlm.nih.gov/32435449
www.antidepressantsfacts.com/effexor-withdrawal6.htm
nytimes.com/2011/07/10/opinion/sunday/10antidepressants.xhtml?pagewanted=all
psychologytoday.com/us/blog/sideeffects/201107/antidepressant-withdrawal-syndrome
pubmed.ncbi.nlm.nih.gov/30292574
cambridge.org/core/journals/epidemiology-and-psychiatric-sciences/article/antidepressant-withdrawal-the-tide-is-finally-turning/8394C10FE317CA5A39B62B86793FC3ED
psychologytoday.com/us/blog/sideeffects/201908/antidepressant-withdrawal-and-scientific-consensus
madinamerica.com/2020/01/researchers-antidepressant-withdrawal-not-discontinuation-syndrome
psychiatrictimes.com/view/international-antidepressant-withdrawal-crisis-time-act
bma.org.uk/what-we-do/population-health/prescription-and-illicit-drugs/prescribed-drugs-associated-with-dependence-and-withdrawal
thelancet.com/journals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext
bpspubs.onlinelibrary.wiley.com/doi/full/10.1111/bcp.14475
bpspubs.onlinelibrary.wiley.com/doi/10.1111
southampton.ac.uk/medicine/academic_units/projects/reduce.page#project_overview%0A
preprints.jmir.org/preprint/25537/submitted
medicine.unimelb.edu.au/research-groups/general-practice-research/mental-health-program/wiserad-a-randomised-trial-of-a-structured-online-intervention-to-promote-and-support-antidepressant-de-prescribing-in-primary-careumcg.nl/EN/corporate/News/Paginas/first-patient-discontinuation-antidepressants.aspx
madinamerica.com/2013/08/ssri-discontinuation-is-even-more-problematic-than-acknowledged
rxisk.org/protracted-antidepressant-withdrawal
psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf
michaelwest.com.au/websites-research-online-advice-on-medications-skewed-by-big-pharma-funding
content.iospress.com/articles/international-journal-of-risk-and-safety-in-medicine/jrs191023
americanaddictioncenters.org/withdrawal-timelines-treatments/anti-depressants
bjgp.org/content/early/2021/04/19/BJGP.2020.0913?fbclid=IwAR0YkYvgtAY_WWj63LUOkLvp3dijcyGQJvlFALz7NEayFzTMgrzhwwWLeYQ#ref-25
journals.sagepub.com/doi/10.1177/2045125320980573
journals.sagepub.com/doi/full/10.1177/2045125321991274
DOI: doi.org/10.1136/bmj.n1065;
“Antidepressants: Evidence on safe discontinuation is lacking, concludes
Cochrane review”. BMJ 2021; 373.
www.theguardian.com/commentisfree/2021/may/17/antidepressant-use-up-covid-side-effects-medication
www.newyorker.com/magazine/2019/04/08/the-challenge-of-going-off-psychiatric-drugs
connect.springerpub.com/content/sgrehpp/early/2021/01/12/ehpp-d-20-00006
pharmaceutical-journal.com/article/news/nice-amends-depression-guideline-highlighting-severe-and-long-lasting-withdrawal-symptoms
www.pulsetoday.co.uk/news/clinical-areas/prescribing/nice-antidepressant-withdrawal-guidance-misleading-and-without-evidence
Patient Experiences
parliament.scot/GettingInvolved/Petitions/PE01651
petitions.senedd.wales/petitions/1235
survivingantidepressants.org/forum/28-success-stories-recovery-from-withdrawal
blogs.bmj.com/bmj/2013/12/04/kelly-brendel-experiences-of-antidepressants-everyone-has-a-story-to-tell/
theguardian.com/society/2013/nov/21/your-experiences-antidepressants-responses
byrdie.com/antidepressant-stories
www.hgi.org.uk/resources/delve-our-extensive-library/case-histories/case-study-antidepressant-experience
nami.org/Personal-Stories/How-Antidepressants-Saved-My-Life
ncbi.nlm.nih.gov/books/NBK361002/
Coming off Psych Drugs: A meeting of the
Minds
wildtruth.net/films-english/psychdrugs/Medicating
Normal
medicatingnormal.com
www.madinamerica.com/2020/10/insane-medicine-chapter-one
Report Your Withdrawal Experience
USA
accessdata.fda.gov/scripts/medwatch/index.cfm?action=reporting.home
Canada
hpr-rps.hres.ca/sideeffects-reporting-form.php?form=voluntary
Guidelines for Switching From One Antidepressant to
Another
withdrawal.theinnercompass.org/taper/reflections-switch-or-not-switch
cks.nice.org.uk/topics/depression/prescribing-information/switching-antidepressants
nps.org.au/assets/Products/Guidelines-switching-antidepressants_A3.pdf
www.members.wokinghamccg.nhs.uk/images/docman-files/southreading/SRCCGTIPS/SRTIPS%2017May2017/GP%20TIPS%2017May2017/Swapping%20and%20stopping%20antidepressants.pdf
Tapering Strips
taperingstrip.com
thelancet.com/joumals/lanpsy/article/PIIS2215-0366(19)30032-X/fulltext
pharmaceutical-journal.com/news-and-analysis/opinion/insight/antidepressant-withdrawal-can-be-a-horrible-experience-are-tapering-strips-a-potential-solution/20207867.fullarticle?firstPass=false
Adverse Effects
madinamerica.com/2016/11/whats-harm-taking-antidepressant
rxisk.org/experiencing-a-drug-side-effect
washingtonpost.com/national/health-science/doctors-often-dont-tell-you-about-drug-sideeffects-and-thats-a-problem/2017/07/28/830fbaf6-715c-11e7-8839-ec48ec4cae25_story.xhtml
hormonesmatter.com/brain-long-term-lexapro-chemically-induced-tbi
breggin.com/studies/Breggin2007.pdf
psycom.net/serotonin-syndrome
rxisk.org/post-ssri-sexual-dysfunction-pssd
health.harvard.edu/womens-health/when-an-ssri-medication-impacts-your-sex-life
rxisk.org/wp-content/uploads/2015/02/2014-Brookwell-SSRIs-and-Alcohol-JRS616.pdf
pubmed.ncbi.nlm.nih.gov/23796469
rxisk.org/driven-to-drink-antidepressants-and-cravings-for-alcohol
madinamerica.com/wp-content/uploads/2017/01/Age-of-Prozac.pdf
rxisk.org/the-dark-is-for-mushrooms-not-for-women
health.usnews.com/health-news/patient-advice/articles/2016-01-13/antidepressants-during-pregnancy-stay-on-them-or-stop
cdc.gov/pregnancy/meds/treatingfortwo/features/ssrisandbirthdefects.xhtml
healthline.com/health-news/do-antidepressants-help-in-long-run#Conclusions-are-tough-to-draw
cepuk.org/unrecognised-facts/long-term-outcomes/
pdfs.semanticscholar.org/c280/181ab5a63ad93dfdc090eace0d3e0865
b6c4.pdf
dovepress.com/long-term-antidepressant-use-patient-perspectives-of-benefits-and-adve-peer-reviewed-article-PPA
news.sky.com/story/long-term-use-of-antidepressants-could-cause-permanent-damage-doctors-warn-11688430
journals.sagepub.com/doi/full/10.1177/2045125320921694
Breggin P R, 2011,Psychiatric drug induced
Chronic Brain Impairment (CBI): Implications for long term treatment with
psychiatric medication, International Journal of Risk & Safety in Medicine,
23: 193-200)
ncbi.nlm.nih.gov/pmc/articles/PMC5347943/?fbclid=IwAR1B6cNzkvCPBRwQyI8VxbDSxHIq45R82jqeTLgNjhRDrrr3-qPR-VUXTG8
bmj.com/content/361/bmj.k1315
uk.finance.yahoo.com/news/antidepressants-taken-millions-significantly-increase-dementia-risk-
pubmed.ncbi.nlm.nih.gov/24502860
care.diabetesjournals.org/content/early/2020/02/12/dc19-1175
madnessradio.net/files/tardivedysphoriadarticle.pdf
psychologytoday.com/us/blog/mad-in-america/201106/now-antidepressant-induced-chronic-depression-has-name-tardive-dysphoria
midcitiespsychiatry.com/treatment-resistant-depression
pubmed.ncbi.nlm.nih.gov/22654508
en.wikipedia.org/wiki/Antidepressant_treatment_tachyphylaxis
healthyplace.com/depression/antidepressants/do-antidepressants-lose-their-effect
Akathisia
akathisiaalliance.org
missd.co
davidhealy.org/left-hanging-suicide-in-bridgend
rxisk.org/illnesses-worse-than-side effects
rxisk.org/akathisia
akathisiainfo.wordpress.com/2012/03/10/akathisia-info
Dependence
withdrawal.theinnercompass.org/learn/primer-psychiatric-drug-dependence-tolerance-and-withdrawal
drugabuse.gov/publications/media-guide/science-drug-use-addiction-basics
nytimes.com/2018/04/07/health/antidepressants-withdrawal-prozac-cymbalta.xhtml
bma.org.uk/what-we-do/population-health/prescription-and-illicit-drugs/prescribed-drugs-associated-with-dependence-and-withdrawal
health.harvard.edu/blog/millions-skip-medications-due-to-their-high-cost-201501307673
thenation.com/article/society/mental-health-insurance-coronavirus
ctvnews.ca/health/canadians-warn-of-self-harm-risk-amid-severe-shortage-of-antidepressant-drug-1.5200797
Drug Interactions
drugs.com/drug_interactions.xhtml
www.rxisk.org/tools/guides
rxisk.org/tools/drug-interaction-checker
www.smartcarebhcs.org/important-drug-interactions-with-the-ssris
Antidepressants and Suicide
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ACKNOWLEDGMENTS
I |
WROTE THIS BOOK in the
hope it will help people make informed decisions about antidepressants and
change how they think about and treat their “mental health”.
There are many people around the
world who work tirelessly to raise awareness of the harm caused by
antidepressants. There are so many advocates and campaigners I am constantly
learning from and whose tenacity and strength never ceases to amaze me. Many of
you have dedicated your lives to preventing harm and raising awareness of this
issue whilst often living with the devastating effects these drugs have had.
This book reflects so much of your amazing work. I thank you all.
In particular, many thanks to my
good and trusted friend and associate Marion Brown. I will be forever grateful
for your constant support. Your Petition, challenging the Scottish Government
to recognize and address the issue of prescribed drug harm and dependence is an
amazing example of the power of the patient voice. Thank you also to Dr. Peter
Gordon and Dr. Sian Gordon, for your valuable friendship and advice.
My gratitude to Dainius Pūras for
his words of support and to Will Hall, James Moore, Jill Nickens, Marion Brown
and Sian Gordon for taking the time to read Antidepressed
and comment. Thanks to Daniel Brummitt for his contribution to the book cover.
This book is for those of you who
are suffering and those who have suffered. I would like to thank the many
individuals who submitted to the Scottish Petition and told of their often life
changing experiences in the hope it would help others. I hope your voices will
now be heard and listened to around the world. This book would not be the same
without you.
I dedicate Antidepressed
to the memory of Antony Schofield and the unknown and growing number or people
whose lives have been cut short or harmed by antidepressants “taken as
prescribed”.
Finally, but not least, thanks to my
husband David for your constant encouragement, belief in me, and unfaltering
support. I couldn’t have done it without you.
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