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Key points
- Millions of people struggle with severe withdrawal effects when stopping or reducing antidepressants.
- Antidepressants are prescribed disproportionately to poorer people, women, and older people.
- Health services around the world have failed to recognise the need for dedicated psychiatric drug withdrawal support services.
This World Mental Health Day (October 10), nearly 8 million adults in England (17 percent of the adult population) will be on prescribed antidepressants. Sadly, none of them will receive any specialised help from the National Health Service (NHS) with the withdrawal symptoms that more than half of them will encounter when they try to come off the drugs.
The number of people on antidepressants has risen every year, internationally, for 20 years. The theme for World Mental Health Day this year is "mental health in an unequal world." In the case of psychiatric drugs, the usual problem of disadvantaged and marginalised groups not getting their fair share of resources is reversed. They are, in many cases, getting too many psychiatric drugs.
In the U.S. and UK, for example, prescription rates of antidepressants are particularly high for women, older people, and people living in deprived areas. In the part of London where I live and work, Newham, about one in every three women over 60 is on antidepressants. These figures reflect the fact that mental health problems are, contrary to psychiatry's dominant medical model, primarily caused by social adversities.
Until very recently, governments had the excuse of ignorance for not doing anything about the millions of people suffering withdrawal effects from psychiatric drugs. The American Psychiatric Association (APA), drug companies, and, in the UK, the Royal College of Psychiatrists and the National Institute for Health and Care Excellence (NICE), had all reported, for two decades, that withdrawal from antidepressants was rare, mild, and lasted just one or two weeks. This meant that people trying to tell their doctor about their withdrawal effects were likely to be told their original problem, e,g, depression or anxiety, was returning
With little or no help available from the NHS, or international equivalents, people have turned, in droves, to the internet for withdrawal support. There has been little research into these peer support communities. But my colleagues and I recently published a study following 13 facebook withdrawal support groups for a year. We found a total membership of 67,125, and an annual growth rate of 28 percent. Group members were 82.5 percent female, as were 80 percent of the administrators and moderators, all of whom are volunteers. The most common reason for seeking out help was failed doctor-led withdrawal.
We concluded: “Further research should focus on the methods of support and tapering protocols used in these groups to enable improved, more informed support by clinicians. Support from governments and healthcare agencies is also needed, internationally, to address this issue.”
Two years ago, I served on the expert advisory panel to a report by Public Health England (PHE), into "Dependence and Withdrawal Associated with some Prescribed Medicines." Dr. James Davies (University of Roehampton) and I published a review of the research on antidepressant withdrawal for the PHE inquiry. We found that 56 percent of people experience withdrawal symptoms when trying to reduce or come off the drugs. Furthermore, nearly half (46 percent) of those people categorised the withdrawal symptoms as "severe," and several studies reported that these symptoms could last for many months.
Following the PHE report, the Royal College of Psychiatrists and NICE (but not the APA or pharmaceutical companies) have updated and corrected their guidance. Finally, more people—at least in the UK—will be told about the risks of severe, protracted withdrawal before deciding whether to take the drugs, and more people will be told that they need to come off very slowly, particularly towards the very end of the tapering process.
Meanwhile, the UK’s psychotherapy, counselling, and psychology associations joined in and produced a “Guidance for Psychological Therapists: Enabling Conversations With Clients Taking or Withdrawing From Prescribed Psychiatric Drugs.” This is important because many therapists and psychologists have paid little attention to clients’ struggles with these issues, often because they see it as "the doctor’s business."
The PHE report called for dedicated local support services for people withdrawing from prescribed medicines, and a national helpline. I am now an advisor to the "NHS England and NHS Improvement" task force commissioned to implement these recommendations. In my view, it will be medically, morally, and financially negligent for the government to continue to ignore the long-denied needs of hundreds of thousands of people across the UK, predominantly women, older people, and poorer people.
My international colleagues tell me that the UK is, on this issue at least, streets ahead of the rest of the world, which is only just beginning to acknowledge the problem exists. World Mental Health Day seems like an opportunity to shine a light on this epidemic of unnecessary suffering and the need for those who contributed to it to step up and help fix it.
The essential first step is for NHS England and NHS Improvement group to implement the PHE recommendations, starting with the dedicated support helpline, which is so urgently needed, as soon as possible.
