Antidepressant Discontinuation Syndrome
As more people turn to antidepressants, they must be aware of issues related to discontinuing them.
The Guardian (London) newspaper recently ran a column on the benefits of antidepressant medicines and the problem of antidepressant withdrawal. The writer was based in Australia where, it was said, one in seven people take antidepressants, the highest rate in the Organisation for Economic Co-operation and Development (OECD), which consists of nearly 50 nations around the world. For more details see here.
Antidepressants have their naysayers in professional circles, but most public health reporting and stories in the media seem to always encourage their use … if needed. When are they needed? Typically, that would be when one receives a diagnosis on Major Depressive Disorder or some other “mood disorder,” but it’s known in America that most prescriptions come from primary care physicians, not psychiatrists or referrals from clinical psychologists.
I am not against antidepressants; I’m not the Robert F. Kennedy, Jr., of antidepressant use. I accept that millions of Americans have been helped by them, though no one knows how they really work. I accept that they work, either from testimonials or their widespread use (or sales would be plummeting, not increasing). I know some critics have dismissed antidepressant success as mere “placebo effect,” but that can’t be a valid criticism. We know that because many, many people need to try different antidepressants before they find one that works. If “placebo effect” were all there was to these medications then we would expect that the first one tried would work, or that doctors could lie and give an actual placebo to the patient!
But we do have to fret over two trends: the increasing use of these drugs by the population, and the problem of withdrawal if and when someone comes off a prescription, as described in The Guardian piece. Fortunately, there seems to be more recognition of Antidepressant Discontinuation Syndrome in America than perhaps some other countries.
Symptoms may include increased anxiety, insomnia or vivid dreams, dizziness, headaches, irritability, and some others.
I certainly don’t know why more people are taking these medication, but a doubling in 20 years in Europe? If twice as many people were being treated for cancer as 20 years ago it would be front page news, top of the fold; it would be the lead story on the nightly news; it would push Biden and Trump off the cable and streaming news platforms.
But here’s a Psychology Today article that gives a pretty well-informed reason as to why we are taking so many antidepressants in America: “Perhaps the fundamental reason why antidepressants are so widely prescribed and used is that they fit with the 'medical model' of mental illness, which has become the standard view in western culture. This model sees depression as a medical condition which can be ‘fixed’ in the same way as a physical injury or illness.” I can also refer you to a well-reviewed book by an old friend of mine from college and psychiatrist Dr. Elio Frattaroli, “Healing the Soul in the Age of the Brain: Becoming Conscious in an Unconscious World,” that makes the above point in spades. In a nutshell, and at the risk of being too reductionist, the argument includes that one might feel “bad” or “down” because of personal problems, a loss of faith in life, disappointment, or other reasons that might not be because of some brain disorder. (Admittedly, this may be a false dichotomy – a disappointment in life may certainly trigger a physiological response that needs medical intervention.)
Now, back to the original problem – coming off antidepressants. I know that allergy medicines don’t “cure” allergies, so that if you need them but stop taking them during pollen season you are going to start wheezing or having scratchy eyes again. It’s controversial whether antidepressants “rewire” the brain (a clear metaphor that is sometimes employed) permanently or just provide temporary relief (once they start to work). If one thinks they actually fix something that’s broken in the brain and that’s that, then one might reasonably think you can come off them. While some people seem to discontinue the medications and are ‘cured,’ in a sense, others see a return of their symptoms, and yet others stop because of side effects or lack of efficacy.
Our Australian friend writing in The Guardian was annoyed that her physician didn’t think her antidepressant withdrawal symptoms could be real because her medication had cleared from her body completely after several weeks, yet they were very real to her. (No one is disputing symptoms can be real in the short run.) It’s a bit like “Long Covid.” Early on in the Covid-19 crisis the reality of Long Covid was disputed, but not anymore. The Australian writer was claiming that antidepressant withdrawal symptoms can last a long time, too, at least for some people.
The Mayo Clinic says the phenomenon of Antidepressant Discontinuation Syndrome is certainly real, and suggests tapering off slowly rather than discontinuing abruptly to minimize the risk. For a longer piece on this subject, see a paper from the Cleveland Clinic Journal of Medicine here. (Incidentally, the Cleveland Clinic reports that 12.7 percent of adult Americans take antidepressants.)
While very few studies appear to exist on the nature of long-term symptoms - more study is needed, as they say - the upshot of the two pieces mentioned immediately above, and others, is that Antidepressant Discontinuation Syndrome is quite real and should be taken seriously.
Before you go:
My latest collection of short stories, “Don’t Go,” has received a very positive review from the respected Midwest Book Review, and has been named a Finalist in the Foreword Reviews INDIES awards for 2022. Read more about it here.