Re: Risk of relapse after antidepressant discontinuation
CCBYNCOpen access
Rapid response to:
Research
Risk of relapse after antidepressant discontinuation in anxiety disorders, obsessive-compulsive disorder, and post-traumatic stress disorder: systematic review and meta-analysis of relapse prevention trials
Re: Risk of relapse after antidepressant discontinuation
Response to authors - and to Dr Drummond Begg’s rapid response
The introduction to the article includes the statement that “antidepressants are a first line option for the treatment of anxiety disorders, as they are effective and generally well tolerated. Most (57%) patients with anxiety disorders who are being treated use drugs. As long term studies are scarce, whether antidepressants should also be regarded a first line treatment option for optimising long term prognosis remains largely unknown”.
Antidepressant side effects can be (and quite often are) devastating for people’s lives and relationships. Commonly experienced side-effects include fatigue, weight gain, sexual problems, digestive problems, diminished empathy and suicidality (1). These side-effects clearly impact every aspect of people’s lives and can ruin relationships and self-esteem, as well as contributing to conditions such as obesity and diabetes.
Many people are now taking antidepressants, as prescribed, over the long term because they have not been supported to ‘come off’ them safely.' Unfortunately it is apparent that GPs have no guidance or understanding of the problems of ‘withdrawal’ – which can be extremely fraught for patients and their families. Instead doctors and researchers tend to view withdrawal problems as ‘relapse’, as evidenced in this article.
For GPs a very readable blog has been written by Kelly Brogan MD – “What’s the harm in taking an antidepressant” (2), summarising and referencing important research published in 2016 “New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal” (1) .
Dr Peter Breggin’s paper “The rational principles of pharmacology”(3) points out ethical considerations.
It so happens that a striking overlap can be found in the experienced effects (side-effects, tolerance, withdrawal and protracted withdrawal) of antidepressants with the multi-system mind and body symptoms which tend to acquire a medical ‘working diagnosis’ of medically unexplained symptoms MUS - which can (and do) become long-term conditions and disability (4).
There is a public petition currently under consideration by the Scottish Parliament Petitions Committee “Prescribed drugs associated with dependence and withdrawal”(5) raising these very issues and a similar public petition has recently been launched in Wales (6) .
Rapid Response:
Re: Risk of relapse after antidepressant discontinuation
Response to authors - and to Dr Drummond Begg’s rapid response
The introduction to the article includes the statement that “antidepressants are a first line option for the treatment of anxiety disorders, as they are effective and generally well tolerated. Most (57%) patients with anxiety disorders who are being treated use drugs. As long term studies are scarce, whether antidepressants should also be regarded a first line treatment option for optimising long term prognosis remains largely unknown”.
Antidepressant side effects can be (and quite often are) devastating for people’s lives and relationships. Commonly experienced side-effects include fatigue, weight gain, sexual problems, digestive problems, diminished empathy and suicidality (1). These side-effects clearly impact every aspect of people’s lives and can ruin relationships and self-esteem, as well as contributing to conditions such as obesity and diabetes.
Many people are now taking antidepressants, as prescribed, over the long term because they have not been supported to ‘come off’ them safely.' Unfortunately it is apparent that GPs have no guidance or understanding of the problems of ‘withdrawal’ – which can be extremely fraught for patients and their families. Instead doctors and researchers tend to view withdrawal problems as ‘relapse’, as evidenced in this article.
For GPs a very readable blog has been written by Kelly Brogan MD – “What’s the harm in taking an antidepressant” (2), summarising and referencing important research published in 2016 “New Classification of Selective Serotonin Reuptake Inhibitor Withdrawal” (1) .
Dr Peter Breggin’s paper “The rational principles of pharmacology”(3) points out ethical considerations.
It so happens that a striking overlap can be found in the experienced effects (side-effects, tolerance, withdrawal and protracted withdrawal) of antidepressants with the multi-system mind and body symptoms which tend to acquire a medical ‘working diagnosis’ of medically unexplained symptoms MUS - which can (and do) become long-term conditions and disability (4).
There is a public petition currently under consideration by the Scottish Parliament Petitions Committee “Prescribed drugs associated with dependence and withdrawal”(5) raising these very issues and a similar public petition has recently been launched in Wales (6) .
1. https://www.karger.com/Article/FullText/371865
2. http://kellybroganmd.com/whats-the-harm-in-taking-an-antidepressant/
3. http://breggin.com/wp-content/uploads/2008/06/Breggin2016_RationalPrinci...
4. https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-017-0592-6
5. http://www.parliament.scot/GettingInvolved/Petitions/PE01651
6. https://www.assembly.wales/en/gethome/e-petitions/Pages/petitiondetail.a...
Competing interests: No competing interests