Tumbling Further Down the Rabbit Hole: the Disturbing World of Antidepressant Withdrawal Research

For those still interested in the recent antidepressant withdrawal debate, here is a new and important instalment.

Before we get to the essential part, let us first recall that our systematic review in Addictive Behaviors (2018) showed, among other things, that around half of people who stop antidepressants experience withdrawal. This conclusion was critiqued in a blog by Joseph Hayes and Sameer Jauhar, to which we responded by pointing out the blog’s many serious errors and misrepresentations (see our response here: http://cepuk.org/2018/11/05/antidepressant-withdrawal-review-authors-respond-mental-elf-critique/

Our response to that blog, however, did not deal with one of Hayes and Jauhar’s core criticisms: that our systematic review had failed to include five randomised control trials (RTCs) [i]. They alleged that these five trials, while primarily focusing on the effectiveness of antidepressants, also contained data on the ‘incidence’ of withdrawal – that is, on how common withdrawal actually is. Had we included this data in our review, Hayes and Jauhar contended, the number of people suffering antidepressant withdrawal would have been lower than we reported, perhaps by around 10% [ii]. It was therefore either remiss or dishonest of us, they implied, not to include data from these studies.

Today, we would like to deal briefly with this particular blog criticism, not merely to show how groundless it is, but more importantly because, by doing so, we gain crucial insight into how shadowy and ethically suspect antidepressant withdrawal research can get when viewed up close.

The first thing to notice when looking at these five ‘studies’ is that the pharmaceutical company, Lundbeck, funded all of them. Additionally, all five studies were undertaken and written (either entirely or in part) by employees of Lundbeck, who reached the conclusion that their antidepressants were superior to competitor drugs.

The second thing to note about these studies is that three of them were not published as full studies at all. Rather, they were published as short ‘research supplements’ – each at around 300 words. For those who do not know much about ‘research supplements’, they are basically industry-funded study-summaries that some journals will publish in return for an industry fee. Needless to say, the obvious conflicts of interests these supplements involve (Lundh et al. 2010) as well as the serious challenges they pose to anyone wanting to assess their methods properly (supplements don’t provide enough detail for that), are just two among numerous ethical and scientific reasons as to why many credible journals, such as Lancet, now refuse to publish them (Lancet 2010).

The third and most disconcerting revelation about these five ‘studies’ and by extension the so-called evidence upon which Hayes and Jauhar base their critique, is that none of the five studies actually contain any data on the incidence of antidepressant withdrawal. To repeat, these five studies do not contain the very data that Hayes and Jauhar alleged we overlooked.

While this, of course, explains why we did not include these studies in our systematic review, it does not explain why Hayes and Jauhar claimed the data was there. We can only surmise that Hayes and Jauhar did not actually check these five studies. Rather, they simply quoted a Lundbeck-funded article, published three years later (by Baldwin et al. 2007), which somehow ‘cites’ data from these original five studies that were never included in them.

Two implications of this arise:

Firstly, and most obviously, by basing their arguments on such dubious foundations, Hayes and Jauhar invalidate many of their core criticisms, such as their view that the overall incidence rate from the RCTs is closer to 40% rather than our 50%, as well as their suggestion that we were not thorough (or even worse, were biased) by not including these five RCTs.

The second implication concerns why such research practices are ever permitted at all. How can a later article cite data from company-funded ‘studies’ that don’t actually report that data (let alone report the mechanisms by which that data was gathered)? And how can individuals, journals and professional communities permit or make use of these suspect practices while also receiving financial succour from the companies set to benefit from them?

Both implications can only add to the growing disquiet within the professional and service user communities as to the impoverished state of psychiatry’s withdrawal research. Where such research exists it is scattered and minimal (and, by design, minimises withdrawal effects). And where such research exerts influence it appears to do so less on behalf of patients (whose withdrawal often lacks proper recognition and support) than on those who promote, defend or evermore widely prescribe this class of psychopharmaceutical.

Dr James Davies

Professor John Read

References:

Baldwin DS, Hindmarch I, Huusom AKT, Cooper J (2004a). Escitalopram and paroxetine in the short and long-term treatment of major depressive disorder (MDD). International Journal of Neuropsychopharmacology 7 (Suppl. 2), S168–S169.

Baldwin DS, Huusom AKT, Mæhlum E (2004b). Escitalopram and paroxetine compared to placebo in the treatment of generalised anxiety disorder (GAD). European Neuropsychopharmacology 14 (Suppl. 3), S311.

Baldwin DS, Montgomery SA, Nil R, Lader M. (2007) Discontinuation symptoms in depression and anxiety disorders. International Journal of Neuropsychopharmacology. 1;10(1):73-84.

Lader M, Stender K, Burger V, Nil R (2004). The efficacy and tolerability of escitalopram in 12- and 24-week treatment of social anxiety disorder: a randomised, double-blind, placebo-controlled, fixed-dose study. Depression and Anxiety 19, 241–248.

The perils of journal and supplement publishing. Lancet 2010; 375(9712): 347. DOI:https://doi.org/10.1016/S0140-6736(10)60147-X

Lundh A, Barbateskovic M, Hróbjartsson A, Gøtzsche PC. (2010) Conflicts of interest at medical journals: the influence of industry-supported randomised trials on journal impact factors and revenue – cohort study. P L o S Medicine. 2 (1);7(10):e1000354. https://doi.org/10.1371/journal.pmed.1000354

Montgomery SA, Durr-Pal N, Loft H, Nil R (2003). Relapse prevention by escitalopram treatment of patients with social anxiety disorder (SAD). European Neuropsychopharmacology 13 (Suppl. 4), S364.

Montgomery SA, Huusom AKT, Bothmer J (2004a). A randomised study comparing escitalopram with venlafaxine XR in patients in primary care with major depressive disorder. Neuropsychobiology50, 57–64.

 

[i] These RCTs were: Baldwin 2004a & 2004b; Lader 2004; Montgomery 2003 & 2004).

[ii] We infer this 10% from the tables they produced in their original blog critique.

11 Responses to Tumbling Further Down the Rabbit Hole: the Disturbing World of Antidepressant Withdrawal Research

  1. Shane Kenny 08/01/2019 at 10:34 am #

    What a murky, dishonest, and profoundly disturbing world of so called “academic research” in the psychoactive drug arena is revealed by Dr James Davies. And it is world wide, not confined to any state, nor linked to any particular politics of right or left, but driven by the naked commercial interests of the pharmaceutical industry – the same driver as that of drug cartels. They are ably assisted by the psychiatric industry ( rather than profession) ranging from the ignorant to the naive and well meaning, but foolish, to the simply corrupt. It is a shame that Dr Davies valuable time has to be wasted exposing this rubbish. Where are our states and governments in dealing with this cancer?

    • Dr. Terry Lynch 08/01/2019 at 2:00 pm #

      Speaking of states and governments, on 5th December 2018 I wrote to Irish Prime MInister Leo Varadkar and MInister for Health Simon Harris, setting out the current debacle that is mental health, including the murkiness of the world of psychiatric drugs and about 20 other key issues.

      My ‘letter’ turned into a 120-plus page document, including over one hundred signatures and 32 personal contributions by people whose own experience of the so-called ‘mental health service’ have convinced them that a major paradigm change is urgently required. To date I have not received a reply, but I will not be letting this go. In the document, I made it clear to Messrs Varadkar and Harris that this mess is ultimately their responsibility.

  2. Michael Freeman 08/01/2019 at 1:20 pm #

    Putting safety entirely in the hands of the industry is not accepted in aviation ( https://www.caa.co.uk/Consumers/Guide-to-aviation/Aviation-safety/ ) so why is it accepted in medicine ? The aviation approach works very well … “There is an average of one fatality for every 287 million passengers carried by UK operators. This can be compared with a one in 19 million chance of being struck and killed by lightning in the UK or a one in 17,000 chance of being killed in a road accident.” (from link above).

    • Rosemary Knowles 08/01/2019 at 2:51 pm #

      – Has anyone calculated the fatalities statistics of antidepressant users by comparison with the aviation industry safety guide? This review under discussion is dealing only with withdrawal effects of users – 56% being affected, and to different degrees. Until we record deaths, and especially suicides, of people suffering withdrawal, we will never change this epidemic of prescribing dangerous drugs to patients. It is time that all GPs and psychiatrists were forced, under pain of being struck off, to record every patient of theirs who has committed suicide or failed suicide, and then all those whose lives have been destroyed by them through broken relationships and an inability to return to work. WE NEED THESE STATISTICS RIGHT NOW.

      • Terry 08/01/2019 at 4:26 pm #

        I completely agree I have been a member of several on line forums for a few years now the harm and devastation that I have seen from these drugs is horrendous and sadly last year on one group alone we lost 12 members to suicide who were so affected by the withdrawal of their medication plus I have seen more suicides on other groups manynare young women and men who had there lwhole lives taken from them because they can find no help or treatments. Where are all the stats on these poor victims who is held responsible there is no justice

      • kiwi 08/01/2019 at 11:19 pm #

        Well said Rosemary.

      • Sarah Ruddock 09/01/2019 at 4:59 pm #

        For every relationship broken, there are probably two families destroyed: children, parents, nephews, nieces, aunts, uncles and grandparents have their world shattered and their health suffers. The economic consequence for the country (as well as for the individuals concerned) must be immense. Has anybody attempted to quantify this?

        With apologies for speaking personally, I have lost my working life and my husband as a result of antidepressants and the time taken to withdraw from them. I have tried to discuss this with an aunt who was a consultant chest physician and worked both for the NHS and privately. She dismisses the matter with words along the lines of “these things happen”. If such an attitude is prevalent amongst older members of the medical profession, what hope is there?

        I too am sorry that Dr Davies has to waste his valuable time exposing this scandal, but am also very grateful that he chooses to do so and will always be interested in the debate.

  3. J.Hill 08/01/2019 at 3:18 pm #

    The issue of harm from prescribed drugs will not simply go away. It also will not be correctly addressed while assuming that the harmful effects represent addiction.
    Reassigning responsibility from medical practice to the consumer has disguised the devastating effects of psycho-active drug withdrawal. To be made ill by a drug is not to be addicted to the drug.

  4. Rosemary Knowles 09/01/2019 at 10:10 am #

    To be made ill by a prescribed drug is plain and simple poisoning by legal and regulated medicines. To then be assessed by a psychiatrist on the basis of your adverse reaction, like euphoria, or hypomania, and given a spurious stigmatising diagnosis from the bonkers DSM, and have a whole series of devastating orders brought against you by a totally ignorant Judge – who cannot work out that a mind-altering drug alters a person’s mind so that they are not themself, and therefore not culpable for their actions under their influence , – is a denial of the patient’s basic human rights. LOGICAL. Madness, or mental illness? The system we operate under in modern psychiatry with psychoactive drugs is plain crazy, stupid and EVIL. We should end it now. Judges in courts of law also need to be educated about these “medications”.

    • Sandra Villarreal 09/01/2019 at 6:20 pm #

      Rosemary Knowles, To become so iatrogenically ill while taking our so called ‘medicine’ that we actually look to suicide to end our suffering needs to be looked at too, and why do we consider such drastic measures? Because our so called ‘Medical Field’ refuses to acknowledge the facts about the drugs,therefore, shifting the blame onto us, the patient (yes, while we have our lives ripped apart & destroyed) accusing us of being: complainers, non-compliant, defective human beings, having addictive personalities.

      If the drugs were not so addictive, actually changing our brain chemistry, we wouldn’t have withdrawal symptoms so mentally horrendous and torturous to the point where putting a gun to our own head seems not only reasonable, but our only option of ending our ongoing suffering.

      By this time something has gone terribly wrong in our brain when we actually entertain thoughts of killing ourselves. It’s not natural. Nor is it normal.Yet the 35 years I was medicated I tried to kill myself over & over by overdosing on my own medicine/drugs to end the drug induced crippling depressions, one resulting in a coma given a 50/50 chance. Only we won’t know this until we’re off our ‘medications’ and the brain regains it’s homeostastis and we’re able to think rationally again, regaining our own mind & soul back again. What I have learned since my multiple cold-turkey withdrawals is the brain does heal, only in it’s time – not ours. I just had to hang on one more day, just one more day, just one more day…

      I loved your comment! Thank you for it.

      • Rosemary Knowles 12/01/2019 at 10:31 am #

        Sandra – Thank you too. We need to start a “me too” site for sufferers and also their families and carers, whose lives are devastated by supporting their loved ones through this hell of withdrawal. I agree with Sarah too. And good luck to Terry Lynch – if Ireland changes tack, we can move there before Brexit happens! The list of people I have appealed to, 2 Health Ministers, the P.M., my own M.P., MHRA, my son’s GP practice many times, NHS complaints, Judicial Conduct Investigations Office, Stephen Fry of MIND, my grandsons’ Head Teacher …..and lawyers to start a medical negligence claim – could take up a website apart from the suitcase in which I store all this mail. To no avail. If this Review does not achieve a total overturning of psychiatry in Britain then we have failed – it is imperative that it does so. My son was head-hunted to a Professorship at age 44.
        2+ years after his poisoning by his GPs – he has lost everything. Criminal.

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