Don't believe the lies - antidepressant withdrawal is a very real crisis

Many people have difficulties stopping antidepressants. Especially if they have been taking these drugs for a long time, when they are at risk of suffering severe and long-lasting effects from withdrawal. I would know - I’ve been a GP for over 30 years with a specialist interest in mental health.

What does withdrawal feel like? ‘Prolonged agony’ says one campaigner, Stevie Lewis, who advocates for better recognition of the problem and support for sufferers. Carrie Clark writes that “antidepressant withdrawal is the single most terrifying and painful thing that has ever happened to me”. In a terrible tragedy, 25 year old Olivia Russell took her own life after suffering terrifying reactions from stopping an SSRI antidepressant. She was a constituent of my parliamentary colleague Esther McVey MP.

These are not new revelations. The medical profession and regulatory bodies have been well aware for over two decades of the risks both of taking these drugs and of trying to come off them. So there is serious concern – combined with disbelief - among many doctors after a new study published last week, which claims that, for the majority of patients, antidepressant withdrawal is largely mild, brief and overstated.

Summarising the research, Dr Sameer Jauhar, a lead author at Imperial College London, has said: “Despite previous concern about stopping antidepressants, our work finds that most people do not experience severe withdrawal, in terms of additional symptoms.” A conclusion that I would certainly not support.

This is a highly misleading piece of research, and I’ll tell you why.

This study draws its findings from mostly short-term clinical trials (most lasting only eight to 12 weeks) with patients’ withdrawal experience followed up for one to two weeks. Of the one in five adults in England prescribed antidepressants, at least half have been taking them for longer than two years, many for much longer. Scandalously, one in eight 12 to 17 year olds have also been prescribed SSRIs. Multiple studies clearly show that longer term use (six months and more) correlates with greater incidence of a range of withdrawal effects.

By excluding most of the real-world data on antidepressant use, the paper delivers a dangerously distorted picture, which denies the experience of millions of sufferers, risks misattributing withdrawal symptoms to relapse of depression, and threatens the very limited support for people in withdrawal.

It also risks harm to others in the future who may be prescribed antidepressants where practical support would be much more helpful and give back agency to the patient, as Minister of State for Care Stephen Kinnock explained recently on BBC Newscast. “So often it's people who are in those difficult [life] situations – with social issues about debt, housing, employment status - come in to see their GP because they've … got real problems with mood, anxiety, depression. In many ways, the last thing they need is a diagnosis. The last thing they need is medication. They just need support, social prescribing, talking therapies.”

Many patients say that if they’d known about the risks, they might not have taken these drugs. Patients should question their doctors about any drugs they are offered, using the acronym BRAN: ask about the Benefits and Risks of medication, the Alternatives and what happens if Nothing is done.

The Beyond Pills APPG has campaigned on this issue for many years, calling for a reduction in antidepressant prescribing for mild to moderate depression and for proper recognition, support and services for those harmed by antidepressant withdrawal. The APPG is collaborating with NHS England and the Specialist Pharmacy Service to organise the ‘Improving Antidepressant Prescribing Programme’, which is supported by the Royal College of Psychiatrists and the Patient Safety Commissioner.

If read uncritically, this new study could cause significant harm by misleading patients, clinicians, guidelines and policy makers. To anyone versed in reading clinical research, it seems the authors have been influenced in their conclusions by evidence that is not scientifically compelling. I fail to understand why these senior doctors do not interrogate the available range of evidence more thoroughly.

The paper has drawn robust criticism worldwide, with many leading experts pointing out the unreliable assumptions. Rather than leading to an update in guidelines, as the authors call for, this flawed and misleading paper should at the very least be amended to reflect its clear limitations, with a formal acknowledgement by the authors. I will be writing to the Chief Medical Officer to this effect.

For any readers – doctors and patients – involved in withdrawal from antidepressants, careful monitoring and tapering is essential. I recommend The Maudsley Deprescribing Guidelines by Mark Horowitz and David Taylor (pub WILEY Blackwell)

Dr Simon Opher is a GP, Labour MP for Stroud and Chair of the Beyond Pills APPG