We thank Hayes and Jauhar for blogging about our recently published systematic review about withdrawal from antidepressants thereby keeping the spotlight on a vitally important issue impacting millions of people around the world.
After decades of silence and minimisation any discussion that maintains public attention is invaluable.
We now invite them to do what is customary in any serious academic debate and submit their blog critique to the journal in which we published, Addictive Behaviors. This way their critique can be properly peer-reviewed, and we can respond to each of their points in the appropriate place and manner, especially because we take serious issue with many of the arguments they raise.
While we disagree with many of their arguments, we do accept, as we did in the review, that some of the 24 studies reviewed had important limitations, as did our best efforts to integrate studies using such varied methodologies.
The fact that there was not more and better research for us to review speaks volumes about whether the prescribing professions have taken the issues seriously. In particular, many of RCT studies employed treatment durations and follow-up protocols that may significantly underestimate withdrawal incidence and duration.
Hayes and Jauhar seem particularly concerned about whether our inclusion of surveys may have biased our estimates that 56% experience withdrawal symptoms when coming off and 46% of those describe them as severe.
We readily concede, as we did in the review, that our estimates are indeed estimates, based on the best available evidence. They may be off by 5% or even perhaps as much as 10%, lower or higher.
Nevertheless, even the most conservative estimate of 46% experiencing withdrawal, and 36% of those at the severe level, would represent a public health issue of significant proportions.
While waiting for the prescribing professions to conduct better studies we hope that all concerned, including those guilty of denial and minimisation in the past, can now work together to acknowledge what thousands of people with direct experience have been trying to tell their doctors for years, to provide full information to people contemplating starting antidepressants, and to lobby for support for the millions trying to withdraw from them.
Dr James Davies & Professor John Read
The story of anti-depressants mirrors exactly the story of benzodiazepines, huge public harm done by these drugs, in the case of benzodiazepines there is much irrefutable evidence of this massive harm over 57 years starting in Leo Hollister’s US study in 1961, but there are always many medics and researchers willing to hastily rush to the defence of the drugs rather than seriously take note of the negatives and understand that the negatives require deep research. This is particularly so in the case of psychoactive drugs, because the brain is such a delicate and vital organ and in the case of benzodiazepines medical science still does not know the full range of their effects and actions in the brain, while the public worldwide have been subjected to a massive experiment and the full truth of the outcome has been ignored or denied because so many have so much to lose if the heavens fall. But in time they surely will.
As someone who has lived experience of the adject hell that is venlafaxine withdrawal, I am hugely grateful to Dr Davies and Prof Read for taking this issue seriously when psychiatry insists on minimising it. My withdrawal from venlafaxine following my psychiatrist’s advised taper over several weeks made me so ill I had to spend 8 weeks in hospital. It was misdiagnosed as a “return of depression”, despite the symptoms being markedly different to anything I had experienced before. Subsequently, therefore, I turned to an internet support group of fellow sufferers for advice about and support with tapering – I have spent the last year tapering slowly and anticipate it will take 2 to 3 more years to get safely off the neurotoxin that is venlafaxine. Even with this slow taper the withdrawal symptoms are at times unbearable. My psychiatrist has since admitted he had no idea venlafaxine caused withdrawal issues, despite prescribing it widely. Until psychiatrists learn to listen to, empathise with and be honest with patients (and themselves) about the adverse effects of venlafaxine, they will continue to devastate lives with their prescription pads. Perhaps they need to start taking and withdrawing from some of the drugs they prescribe, so they can experience their adverse effects first hand?
It seems to me that most of people are not aware that the so call “antidepressants” are given to all kind of patients, including the ones that suffer from “psychosis” and other “mental health illness” mixed with antipsycotics and other kind of “mood stabilizers”, therefore to start with people should be clarified first what is going on with the psychiatry in general as although is not better or worst the simptomology of a person suffering a depresion or another with abnormal thoughts is indeed very different. In both cases antipsicotics and antidepressants can become a big trap for the rest of their lives, as not even the psychiatrist know what they are doing, as long as the patient is aware of that and wants to runs the risks that is another matter.
I stated this on other section “It seems to me that most of people are not aware that the so call “antidepressants” are given to all kind of patients, including the ones that suffer from “psychosis” and other “mental health illness” mixed with antipsycotics and other kind of “mood stabilizers”, therefore to start with people should be clarified first what is going on with the psychiatry in general as although is not better or worst the simptomology of a person suffering a depresion or another with abnormal thoughts is indeed very different. In both cases antipsicotics and antidepressants can become a big trap for the rest of their lives, as not even the psychiatrist know what they are doing, as long as the patient is aware of that and wants to runs the risks that is another matter.”
Thank you Dr James Davies and Prof. John Read, for the original survey and for this response to the Mental Elf review.
I have been dealing with the side effects and withdrawal effects of anti-depressants for 12 years now (the first 8 years I didn’t even realise they were side effects and mild withdrawal) I didn’t even KNOW there were potential withdrawal effects, no one, the Dr who prescribed or the patient information leaflet, apprised me that this could happen.
I don’t even think the prescribers are that aware that the prescribing protocols or guidelines that they work to can cause tremendous debilitating effects – eg. being cycled through a number of different anti-depressants in about six months. After the last change I was on my knees and since then I have slowly come to realise that what likely happened is that when one drug was changed to another, I was in withdrawal from the previous drug, when another was then added and so on as I went through four drug changes. The effect, in my view, was cumulative withdrawal. I was a complete mess of anxiety, insomnia, sensitivity to sound and people, exhaustion etc.
I don’t remember what the Dr. advised at this point – all I knew was that I was close on collapsing and cold turkeyed. I didn’t know that this was particularly risky – I had no knowledge or information to help me make some kind of reasonable decision (if, indeed there was one, given the state I was in).
The next three years were a torment of increasingly severe withdrawal effects – the works: anxiety, insomnia, nausea, retching, exhaustion, constant need to urinate, dizziness, unbalanced feeling, wooziness, panic attacks. The internet helped me to understand what was happening. The notion of withdrawal effects were dismissed by my Dr.
The culmination of these events was a physical breakdown nearly two years ago, with severe and unremitting anxiety. I went through the mental health service, the Psychiatrist also denying withdrawal effects. Without proper knowledge from the professionals (who we expect to know cause and effect) I was labelled with major depression with agitation.
Not knowing what could be done to help, I succumbed to psychoactive drugs again, clutching at any straw that might give me relief from the torture of the 24/7 anxiety and suicidality, the insomnia, the weak and wobbly legs and the utter physical illness I felt. I am now on three drugs. My legs are still weak and wobbly, I am constantly tired, my life is severely restricted, and I deal with other symptoms.
These are not psychosomatic symptoms of a trauma that has been buried (as the psychiatrist diagnosed) – they are the horrendous effects from the drugs.
I do hope, as you say, that the “discussion … maintains public attention”, I know there are big forces at play and that the profession appears to be resistant to acknowledging the true harms that can be inflicted by these drugs. But a good starting point is that the general public become better informed.
I am deeply grateful for your contribution to this and hope that ensuing generations will be the safer for it.
I have submitted the following response to the Mental Elf critique on the Mental Elf blog:
Dear Dr. Joseph Hayes and Dr. Sameer Jauhar:
Your blog above is advertised above as “NO BIAS, NO MISINFORMATION, NO SPIN.” Accordingly, the following questions are even more appropriate to ask of you, especially given your own above admitted conflicts of interest which include working as a “Consultant Psychiatrist” and your own above broadened scrutiny of conflicts of interest to include “ideological or intellectual conflicts of interest” which “are not discussed” which could be charged against any author with a true ideological or intellectual interest in just seeking lifesaving truth no matter what the personal cost:
Question 1: As Dr. Neil MacFarlane appropriately comments above, what specifically and exactly do you mean by stating “ideological or intellectual conflicts of interest are not discussed” (and also in answering please apply the same standard to your own above critique)?
Question 2: Have you applied the same degree of critical scrutiny and rigor (as you have to the above article) on the research used to justify the current UK and USA antidepressant-use standards of care (including any differences between UK and USA standards) including the research used to justify and validate the nosology used in such standards of care-justifying research, and if you have indeed done this, where are the results of such a “NO BIAS, NO MISINFORMATION, NO SPIN” critique?
Question 3: In your “No Bias” critique answer for Question #2 above, and in your own professional practice of psychiatry in general [especially given the lack of biological markers to prove material brain function abnormalities in psychiatric diagnoses which lead to antidepressant prescribing, as well as, the known brain function abnormalities (including chemical imbalances) that antidepressants iatrogenically cause (e.g., please read the twelve best-in-class references in my links below)] how have you scientifically controlled for the expected huge confounding variable of human soul function as discussed in my epistemological axioms presented in my 5/2/18 letter to the editor of the British Medical Journal and my 8/16/18 Medicaid.gov public comment available for free at the following two URL addresses in the context of two real-life current events U.S. public health policy examples? Note, I ask this because we cannot scientifically rule out an obvious expected interface between human soul function and material brain function which, as a result of research design, is abnormally affected only in those research subjects receiving the psychotropic drug with, therefore, expected possible significant iatrogenic soul-function-brain-function-interface abnormalities causing possibly primarily clinically significant soul function abnormalities which are not being detected because soul function is not being scientifically measured and therefore which may be significantly contributing to the mounting findings of huge under-appreciated iatrogenic effects (including significant morbidity and mortality and disability) from antidepressants and other psychotropic drugs as reported in the twelve best-in-class expert witness references cited in the following links:
Sincerely and In Biblical Love for Both of You and All Psychiatrists Everywhere,
Thomas Steven Roth, MBA, MD
Christian Minister for Biblical Medical Ethics,
Religious and Scientific Refugee from the Clinical Practice of Psychiatric Standards of Care
P.O. Box 24211
Louisville, KY 40224
October 26, 2018
Saying “Evidence-Based Psychiatry” is exactly the same thing as saying “Evidence-Based Phrenology”, or “Evidence-Based Astrology”. Psychiatry *itself* is a pseudoscience, a drug racket, and a means of social control. Psych drugs are far less safe, far less efficacious, and far less necessary than we’ve been LIED to believe. I’m proof of that.
I have submitted the following response to the Mental Elf blog:
Regarding the position of Drs. Jauhar and Hayes in their recent paper “The War on Antidepressants”, based on the above article:
It is bizarre that a spotlight on a potentially serious adverse effect of a class of drugs is cast as a war on the drugs themselves.
The assumption that antidepressant withdrawal symptoms generally are mild, transitory, and last only a few weeks was promulgated in a pair of supplements to the Journal of Clinical Psychiatry in 1997 and 2006 arising from “expert” symposia sponsored by pharmaceutical manufacturers Lilly and Wyeth, respectively, and led by the notorious Dr. Alan Schatzberg.
The conclusions of the “consensus panel” were based only on the opinions of the participants. There was no data or real evidence involved. No citations were given for the statements about the severity of withdrawal syndrome.
These papers are buried in the citations of nearly all other medical literature about antidepressant withdrawal syndrome, with the erroneous assumptions circulated over and over until they calcified throughout psychiatry into “evidence.”
To his credit, one of the experts from Schatzberg’s “consensus panel,” the UK’s Dr. Peter Haddad, repeatedly has made an effort to remedy this misinformation, authoring many papers about withdrawal syndrome and warning about its misdiagnosis. He has pointed out repeatedly that withdrawal symptoms may be relatively mild only in most cases — there are exceptions, the extent of which is unknown.
As Dr. Haddad stated in 2001: “Discontinuation symptoms have received little systematic study with the result that most of the recommendations made here are based on anecdotal data or expert opinion.” (Haddad, P.M. Drug-Safety (2001) 24: 183. https://doi.org/10.2165/00002018-200124030-00003)
I also had personal correspondence in 2006 with another member of the expert panel, Dr. Richard Shelton, who admitted to me that some individuals can suffer severe and prolonged withdrawal syndrome. (Like Dr. Schatzberg, Dr. Shelton went on to a lucrative career as a pharmaceutical company consultant.)
The “experts” who presented their opinions as evidence informing medicine’s assumptions about psychiatric drug withdrawal are well aware they have not disclosed all the risks. Consequently, physicians everywhere have a false sense of safety about these drugs and are blind to the adverse effects.
However, given the extremely high rate of psychiatric prescription, the expedient gloss over the potential of injury has caused damage to millions of people.
In correspondence years ago with Dr. Haddad, he hinted that gathering case histories would be instructive in this debate. On my Web site, SurvivingAntidepressants.org, I have gathered almost 6,000 case histories of difficult psychiatric drug withdrawal, none of them mild, transient, and lasting a few weeks. You can see them here http://survivingantidepressants.org/index.php?/forum/3-introductions-and-updates/
These case histories also demonstrate the many, many ways people are being misdiagnosed and misprescribed. Taken together, they’re a landscape of the pitfalls in medical knowledge regarding psychiatric drugs and their adverse effects.
Another critic of the Read and Davies paper, Dr. Ronald Pies, recently contended in Psychiatric Times (https://www.psychiatrictimes.com/couch-crisis/sorting-out-antidepressant-withdrawal-controversy and comments) that psychiatrists know how to taper people slowly off drugs and therefore serious withdrawal syndrome as reported by Read and Davies is nearly non-existent.
Dr. Pies’s claims are based solely on his own 2012 paper, in its prolix entirety at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3398684/, in which he states:
“In my own practice, I would typically “wean” a patient off a chronically administered antidepressant over a period of 3 to 6 months and sometimes longer. To my knowledge, this period of tapering has rarely, if ever, been used in existing studies of antidepressants or in routine clinical practice.”
Dr. Pies knows very well that “proper psychiatric care” for tapering “managed appropriately” is virtually impossible for patients to find. This tends to confirm Davies and Read are on the right track.
Longer taper periods would definitely be better than the haphazard ways physicians, psychiatrists included, are tapering people now. Calling preliminary investigation into a common adverse reaction a “war on antidepressants” does nothing to advance patient safety. Drs. Read and Davies are correct, we need better ways to taper people off psychiatric drugs.
Let me firstly start out by saying that I do not agree with this websites core philosophy that antidepressants are largely ineffective and I do not believe withdrawal from antidepressants is a huge public health issue. I believe in the benefits of antidepressants and even benzodiazepines but I will say this, to which I thank this website for opening my critical thinking skills on:
Lots of patients on antidepressants will take it to their deathbed. Antidepressants are seen as very safe because people getting off of them is rare as many doctors believe that when someone says they feel better and they no longer need the med that “getting off the med will put you back into depression. Your issues have been resolved leading your depression to go down and the antidepressants are fully working to alleviate symptoms.” So doctors don’t wish to get patients off! I know I’ve been told not to get off Effexor even though I feel my depression is under control. (Not gone but better.)
Research has also been rare and the FDA/NIH and the British NHS haven’t really allocated grants or funding into antidepressant withdrawal. The FDA fined the makers of Cymbalta for misleading information after reports of it being hard to withdraw were increasing. But the FDA never made Pfizer do a study on it or more importantly never gave a grant for a third party unbiased research team to do a study. They fined them and that was it. They didn’t demand them make capsules in more doses below 20mgs so one can better taper, they didn’t issue an alert to prescribers about harm, etc (Note: while all antidepressants cause withdrawal symptoms or at least can, Duloxetine has a notorious reputation. 1. They advertised so much leading it to become one of the most widely prescribed. 2. It is one of the less effective antidepressants so it is common for patients to wish to try something different. 3. Upon trying, patients often still have withdrawal effects when switching. Withdrawal symptoms are not reportedly bad when switching from one SNRI to another or SSRI to another but in the case of Duloxetine, it has been shown to be a nightmare.)
Until we address mental health in an integrative approach requiring therapy, we s allocate funding for research, we educate doctors on current findings, etc, antidepressants will always be prescribed without a blink and doctors won’t care to take someone off even when taking it becomes unnecessary. I think that’s also important to mention. When someone doesn’t need antidepressants anymore, they need to be taken off. Yes, it’s true that a lot of people think they are ready to get off and when they do their depression comes back. This is why we need lower doses of these meds to taper and doctors can see. Is the taper making them feel depressed? Okay then maybe they need to stay on. Are they perfectly fine aside from a few withdrawal symptoms? Okay then let’s get them off. The notion that people on antidepressants who later (years even) eventually say they are no longer depressed cannot be given credit to antidepressants ridding their depression. Obviously their circumstances have changed or they wouldn’t feel depressed but relief from antidepressants to feeling complete relief. I don’t know why doctors don’t evaluate and see if the antidepressants are stopping their depression or if their depression just went away.
Then my final point is no one believes depression is a permanent condition but it is treated as such. We’ve got to reconceptualize when it is appropriate to get people off.
In terms of withdrawal symptoms, we are all different. I had major problems getting off Cymbalta and Prozac (at different times of course.) Chest Pain was my biggest issue. I’ve had no problems getting off others but we are all different.
In terms of Benzos I’m one of the 10% who gets very very sick with no timeframe from tapering. I’ve tried six times, one cold turkey, and I’ve had a seizure every time. One was while I was driving leading me in a wreck with a broken foot and hitting two cars. Most people never experience this. But us 10% or less that do, it’s hell. It’s not worth risking even for the sake of a 5% chance of getting these symptoms to put one on a regimen unless warranted. These symptoms are no joke and even though maybe only 5-10% of us get them, they are completely dehabilitating. They will stop ones ability to function in the world. People won’t be able to work, drive, go out in public, etc and for many if they don’t work, their families don’t eat. The small 5-10% chance is still so devestating to ones mind and body that even such a small chance shouldn’t be something a doc wishes to gamble with. My uncle got off 3mg Klonopin after 17 years cold turkey with no problem. I can’t even make a .075mg cut without losing vision. And I’ve seen many psychiatrists and only one knew about this possibility. The others didn’t even believe me! They thought it was increased anxiety causing physical manifestations. I tell all my friends who get Benzos even PRN to not pick up a script of 30 or 60 because they could easily start a regimen without realizing. After what they’ve seen to me, surprisingly most listen