This is Part 1 of 2
Beverley Thomson is a writer, researcher and speaker with a focus on psychiatric medication including antidepressants, benzodiazepines and ADHD drugs; their history, how the drugs work, adverse effects, dependence, withdrawal and development of patient support services. Her aim is to help inform and empower the patient to make informed choices about medication. She has a particular interest in withdrawal management and prescription drug-induced suicide. In the past 10 years, she has worked with organizations such as the British Medical Association, the Scottish Government (as part of a working group addressing the issue of prescribed drug harm and dependence in Scotland), the UK Council for Evidence-Based Psychiatry (writing evidence-based summaries to be used by professionals and the general public), and the UK All Party Parliamentary Group for Prescribed Drug Dependence. She has contributed to articles in the British Medical Journal (BMJ) and mainstream media including TV and radio.
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As humans we instinctively act to our advantage. In some cases, this is often done to the detriment of others, known as opportunistic behaviour. Whilst opportunistic behaviour is deemed acceptable or at least inevitable in the commercial world, is opportunistic behaviour ever acceptable when it comes to patients seeking help with or harmed by antidepressants or other drugs used in mental health? When it comes to deprescribing and treating iatrogenic harm caused by conventional medicine, is ‘making every contact count for profit’ something we should question?
With the ongoing call for a shift in how we view and treat our mental health, much progress has been made in the last few years to raise awareness of the potential harm caused by antidepressants and other drugs used to treat our depression and anxiety. Unfortunately, for many, this has all come too late and at a disastrous cost to their health. The paradoxical effects of these drugs have left millions suffering dependence, irrevocable harm and desperately in search of help to restore equilibrium of both mind and body. As the search for freedom from psychiatric drugs has increased, we have seen the appearance of many commercial organisations and professionals offering their services to help people to withdraw from the drugs and post withdrawal.
Notwithstanding the progress being made to establish some well-intentioned, reliable, and affordable services, have patients suffering iatrogenic harm become vulnerable to the exploitation of those marketing themselves as ‘restorers of health’? Often making what seem exploitative, spurious, and unprincipled claims that they have the powers to successfully withdraw people from psychiatric medication, is this emerging, fast growing industry of professionals and services profiting financially from a mass market of desperate patients harmed by prescribed medication?
We are once again being seduced by a new language. There is talk of services for withdrawal being functional, Integrative, alternative, and using holistic assessments including lab testing and diagnostic tools. It is about the natural balancing of neurochemistry. There are claims that by addressing biophysical and psychological factors the balance of the brain can be naturally restored. It can take combinations of supplements, organic diets, dedicated and personalised care management, investigative research into medical contributors, Chinese medicine, licensed counselling, and use of a never-ending list of holistic modalities. We are now being told our brain and body can heal themselves following exposure to psychiatric drugs, but we are rarely shown the evidence. Taking antidepressants causes the brain and central nervous system to change their structure and functioning, but where is the proof after long-term exposure they can learn to live without the drugs and function normally once the drugs are withdrawn? Just as in the early 1990s when carefully scripted pharmaceutical marketing campaigns such as ‘Defeat Depression’ created the belief it was our chemical imbalances and brain biochemistry at fault, are we once again being duped by marketing which in time will be proved questionable science?
I agree we need a different perspective when it comes to treating our mental health and consideration of our lifestyle choices are important, but it is perhaps in our healthy, homeostatic state, prior to any iatrogenic harm, that functional medicine really has its place. Surely it is a speciality which should be focusing on maintaining health rather than repairing the damage done by iatrogenic harm. Claims natural methods can be used to restore balance when the imbalance has been caused by taking or withdrawing from powerful psychoactive, psychotropic medication might seem questionable.
The first systemic review on antidepressant withdrawal was not published until 2015.1 In 2019, ‘Withdrawal - the tide is finally turning’2 made the case that withdrawal from antidepressants is often long lasting and severe. The experts in the field have produced much needed guidelines on withdrawal and patients have produced invaluable anecdotal evidence, but reality is theory and practice seem worlds apart when it comes to the practicalities of such a complex individual issue. A recent UK study, ‘‘Stabilise-reduce, stabilise-reduce’ A survey of the common practices of deprescribing services and recommendations for future services’,3 highlights the need for the establishment of services to help people to safely stop prescribed drugs associated with dependence and withdrawal. The global survey identified only thirteen existing deprescribing services, (8 in the UK, 5 from other countries).“The common practices in the services were: gradual tapering of medications often over more than a year, and reductions made in a broadly hyperbolic manner (smaller reductions as total dose became lower). Reductions were individualised so that withdrawal symptoms remained tolerable, with the patient leading this decision-making in most services. Support and reassurance were provided throughout the process, sometimes by means of telephone support lines. Psychosocial support for the management of underlying conditions (e.g., CBT, counselling) were provided by the service or through referral. Lived experience was often embedded in services through founders, hiring criteria, peer support and sources of information to guide tapering.”
The study concludes there is a need for further research to clarify best practice and recognises effective deprescribing is an international issue as more individuals around the world become exposed long-term to drugs associated with dependence. Antidepressant withdrawal is thought to affect 56% of people who attempt to stop these drugs, with up to 25% reporting withdrawal symptoms as severe. 4 It is clear there is a lack of official guidance on withdrawal, tapering and symptoms. There is a need for the involvement of people with lived experience of withdrawal. These services should be separate to addiction clinics. This report details future directions and research recommendations.
The current dilemma is that doctors are being advised to address overprescribing, patients are becoming more aware of the harmful effects of prescription drug dependence, but this lack of free or affordable withdrawal and support services is opening the doors to unregulated commercial opportunities. The marketing and prescribing of psychiatric medication have long been opportunistic ventures and ironically the deprescribing of these drugs now presents another opportunity to put profits before patients. Those prescribing the drugs are the ones who know least about deprescribing and withdrawal. The lack of professional medical support often leaves patients with two options; either they become one of thousands joining internet peer support groups which are providing guidance, or they pay a private clinic thousands of dollars, putting their faith in claims such as “we can do investigative work that can isolate the factors that need to be brought into balance”.
“If I thought that it was possible, I would have opened a string of clinics all over the country to help people off of antidepressants. Unfortunately, the problems that often occur when people try to stop an SSRI antidepressant are much more severe and long-lasting than the medical profession acknowledges, and there is no antidote to these problems” says psychiatrist Dr Stuart Shipko. 5 If there really is no antidote to these problems, are some commercial services exploiting both those wishing to withdraw from antidepressants and those suffering negative effects of withdrawal?
In his book ‘Functional Medicine for antidepressant withdrawal’, James Greenblatt, MD, tells us ‘There is currently zero field-wide consensus regarding antidepressant discontinuation best practices. In addition to a stunning ethical failure, this represents a serious void in the psychiatric model… a riddle that too many patients and clinicians are being forced to solve alone.’ His book is ‘a comprehensive, evidence-based paradigm for antidepressant discontinuation that prioritizes the repletion of underlying nutritional deficiencies. Bridging concept and application, it provides health professionals with clinically proven tools for mitigating antidepressant withdrawal and guiding patients successfully through taper. It also reveals a path to the standard of care that we all deserve, one illuminated by science and upheld by the mandates of ethical, conscientious, personalized medicine.” 6
1 Fava GA, Gatti A, Belaise C, Guidi J, Offidani E. Withdrawal Symptoms after Selective Serotonin Reuptake Inhibitor Discontinuation: A Systematic Review. Psychother Psychosom. 2015;84(2):72-81. doi: 10.1159/000370338. Epub 2015 Feb 21. PMID: 25721705.
2 Hengartner MP, Davies J, Read J. Antidepressant withdrawal - the tide is finally turning. Epidemiol Psychiatr Sci. 2019 Aug 22;29:e52. doi: 10.1017/S2045796019000465. PMID: 31434594; PMCID: PMC8061160.
3 https://doi.org/10.1371/journal.pone.0282988
4 Davies J, Read J. A systematic review into the incidence, severity, and duration of antidepressant withdrawal effects: Are guidelines evidence-based? Addict Behav. 2019;97: 111–121. pmid:30292574
5 https://www.madinamerica.com/2013/08/ssri-discontinuation-is-even-more-problematic-than-acknowledged
6 https://www.psychiatryredefined.org
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