How antidepressant withdrawal presents itself, and how to help people withdraw safely

Stevie Lewis (above left) is a campaigner and board member of the International Institute of Psychiatric Drug Withdrawal. Dr Mark Horowitz (above right) is a clinical research fellow in psychiatry at University College London and the NHS. The following text was co-written by them.

 

Prescribers ill-equipped to recognize, address withdrawal syndrome

Patients’ actual experience of taking antidepressants is very different from prescribers’ expectations.  Research shows that 56% of people taking an antidepressant will experience withdrawal, and 46% of those will describe their withdrawal as severe (Read, Davies 2019).  Therefore, if prescribed an antidepressant, you are more likely than not to go through some form of withdrawal.

One of the reasons people become physically dependent on antidepressants, especially SSRIs (selective serotonin re-uptake inhibitors), is that prescribers have been led to believe that antidepressants are not dependence-forming.

Official Guidelines have told them that dependence is rare and withdrawal short and self-limiting to a couple of weeks.  As a consequence, prescribers do not recognise withdrawal, and they assume the presenting symptoms are the re-emergence of the original illness or a new illness.  This leads to people staying unnecessarily long term on the drugs.

New video will educate doctors and patients on safe withdrawal

The International Institute of Psychiatric Drug Withdrawal (IIPDW) will soon be releasing a 45-minute training video, funded by Open Excellence and produced by MindWick.

The video will explain to doctors and members of the public how antidepressant withdrawal presents itself and how to help people withdraw safely from antidepressants.

Stevie Lewis is a campaigner and board member of the IIPDW.  She took an SSRI for 17 years, the majority of which was spent trying and failing to stop because the withdrawal effects were so severe.  Dr Mark Horowitz is a clinical research fellow in psychiatry at UCL and the NHS. He has a PhD in the neurobiology of antidepressants from the Institute of Psychiatry at King’s College London. He has published papers on safe tapering in the Lancet Psychiatry and authored the Royal College of Psychiatry guidance on ‘Stopping Antidepressants.”

The video is a two-way discussion between Stevie and Mark, in which Stevie describes her time on the drug and her protracted withdrawal and Mark explains the science behind her experience.  Mark clearly defines “physical dependence” and how the body and brain change as a result of taking psychiatric medication.

He describes withdrawal symptoms and how they can be distinguished from relapse/re-emergence of the original illness or onset of a new illness.  He gives specific guidance on how to safely withdraw by hyperbolically tapering the drug.  This information is crucial to prescribers and members of the public alike, and is currently not available in the official guidance in most countries.

Stevie’s own experience of taking an antidepressant could have been so different (and so much shorter!) had prescribers at the time known what we know now about these drugs.  Firstly, she would have been given a clear description of the risks associated with taking a dependence-forming drug at the outset, and as a consequence could have given informed consent.

There would have been a clear plan as to how long she should take the drug.  The early emergence of the side effects that can be life-threatening, such as akathisia, would have been discussed.  Plus dependence and how it occurs would have been clearly explained, withdrawal symptoms recognised when they appeared, and a tapering schedule put in place.

None of this knowledge or vocabulary was passed on.  Our aim for the film is that from now on, it always will be.

Be the first to see the film, subscribe now to the Institute’s newsletter!

 

References
A systematic review into the incidence, severity and duration of antidepressant withdrawal effects: Are guidelines evidence-based?

 

 

 

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