No doubt you saw the recent, almost jubilant, headlines about a new research review that claimed withdrawal from antidepressants largely causes only mild symptoms and is short-lasting.
It was big news. Antidepressants are currently taken by more than eight million people in England alone, with prescriptions at an all-time high.
Lots of people say that taking antidepressants has helped them. But antidepressants are also controversial. Some experts think their benefits have been exaggerated and their side-effects minimised.
For example, antidepressants are recognised to cause dependence and withdrawal symptoms. Originally, these were thought to be only mild and short-lived, but in recent years, as patients reported they experienced severe symptoms that lasted for months – even years – institutions such as the Royal College of Psychiatrists and the National Institute for Health and Care Excellence (NICE) have updated their advice on antidepressants to reflect this.
However, in the past few months, some doctors have tried to reassure the public that withdrawal symptoms are not a significant problem after all, and have called for the updated advice to be changed.
Professionals like me are worried this will mislead people about the risks of these drugs and will result in more taking antidepressants long-term.
The longer you take anti-depressants, the more likely you are to develop physical dependence and withdrawal symptoms – and that’s on top of other side-effects, such as sexual dysfunction, weight gain, osteoporosis and an increased risk of heart problems and bleeding.
When modern antidepressants, such as the SSRIs, which include fluoxetine (brand name Prozac) and sertraline, were introduced in the late 1980s and 1990s, they were hailed as safe and ‘non-addictive’. This helped distinguish them from benzodiazepines (e.g. Valium and Librium), which by then were increasingly criticised for causing dependence and withdrawal effects.
The longer you take anti-depressants, the more likely you are to develop physical dependence and withdrawal symptoms – and that’s on top of other side-effects, such as sexual dysfunction, weight gain, osteoporosis and an increased risk of heart problems and bleeding
History repeats itself, it seems. By the 1990s, people were reporting that the SSRIs produced withdrawal effects, too.
These drugs didn’t cause craving or make people high like benzodiazepines could, but when some stopped their antidepressant, they experienced withdrawal symptoms including dizziness, brain zaps, anxiety and low mood. Still, the symptoms were said to be brief and mild. However, as increasing numbers of patients described their excruciating and disabling withdrawal symptoms, in 2019 the Royal College of Psychiatrists changed its advice – while a Public Health England investigation led, in 2022, to new NICE recommendations on how to avoid and treat antidepressant dependence and withdrawal problems.
A key review of the existing research, published in 2019, suggested antidepressant withdrawal might occur in around half of users, and could quite often be severe. Recently, though, two groups of researchers have claimed the evidence shows something different.
Last summer, a team in Germany published a review of studies, and claimed this showed that while antidepressant withdrawal existed, it was not common, and rarely severe.
A British team came to a similar conclusion earlier this month.
But both reviews were based on studies involving people who’d taken antidepressants for only a short time (mostly a few weeks), yet we know that dependence and withdrawal symptoms usually set in after people have been using the drugs for months or longer (many are on them for years).
Also, many of the studies in the German review were not designed to assess withdrawal symptoms, and were likely to have missed them.
And when an international group of colleagues and I conducted a thorough re-analysis of the German review, we identified that only five of the 65 studies included measured withdrawal symptoms in a systematic way. Even then, four of these studies lasted for just 12 weeks or less, and one involved the antidepressant agomelatine, which is not an SSRI and is not thought to cause withdrawal symptoms anyway.
A review of existing research, published in 2019, suggested antidepressant withdrawal might occur in around half of users, and could quite often be severe, writes Professor Moncrieff
Nevertheless, these five trials showed that 55 per cent of people reported experiencing at least one withdrawal symptom after discontinuing antidepressants. In other words, the robust research in this review actually showed that withdrawal symptoms are an issue.
The recent British review confirmed this, revealing there was clear evidence of withdrawal effects in people taking common antidepressants even though they had only been on them for eight to 12 weeks.
The authors concluded that the effects were not severe enough to be significant – hence the recent headlines.
But this was the authors’ judgment – not what the participants reported. There were other major flaws in the reviews.
Withdrawal symptoms vary from person to person and most likely by the type of antidepressant too, but it’s clear that some people experience symptoms that are severe and prolonged. These can lead to them having to give up work, to relationship breakdowns and even, rarely, make them suicidal.
It is worrying that some psychiatrists seem keen to minimise the potential problem of withdrawal. Sweeping this under the carpet means more and more people will get stuck on these drugs long term. They will suffer the side-effects of antidepressants, even if they’re getting no benefit from them.
And people need to have this information upfront, so that they can make properly informed choices about the medicines they choose to take.
Professor Moncrieff is a psychiatrist based at University College London and author of Chemically Imbalanced: The Making and Unmaking of the serotonin Myth (Flint).
This article was originally published by a www.dailymail.co.uk . Read the Original article here. .