Stevie Lewis went to see her GP for help with insomnia after struggling with the pressures of starting up a business consultancy. The 41-year-old from Bristol hoped she’d be given something to help her sleep.
‘But to my surprise the doctor announced that I was on the edge of clinical depression — what my mother’s generation would have called a nervous breakdown,’ she recalls.
And instead of sleeping tablets, she was given a prescription for paroxetine, a type of antidepressant known as a selective serotonin reuptake inhibitor (SSRI), thought to work by increasing the level of a mood-enhancing brain chemical, serotonin.
Hooked: Stevie Lewis, from South Wales, went to see her GP for help with insomnia – but was told she was on the cusp of clinical depression…and given addictive anti-depressants
‘I was completely shocked, not least when he told me I had a chemical imbalance in my brain,’ says Stevie, who now lives in Rogiet, South Wales. ‘I thought very carefully about whether I should take this drug, but in the end I did, because I believed him — he was my doctor.’
However, her shock at being prescribed an antidepressant was nothing compared with the horror that awaited her when she tried to wean herself off paroxetine.
Stevie did not know this was the start of a 20-year battle to extricate herself from the grip of a drug she never needed, during which she would struggle with appalling side-effects that doctors refused to acknowledge were caused by withdrawal, dismissing them as a return of her original symptoms.
Antidepressants, she was told emphatically, weren’t addictive and she could stop taking them whenever she felt like it. But when she tried, she found herself running a gauntlet of horrific side-effects, including extreme anxiety and an irrational terror of everyday acts, objects and places. At times, she felt she might be going mad.
But, as revealed in the Mail today, a major new study suggests that far from losing her mind, Stevie, like millions of patients, was indeed experiencing drug withdrawal.
The review, one of the largest ever carried out of studies investigating the incidence, severity and duration of reactions to antidepressant withdrawal, concludes that the phenomenon is not only real, but ‘more widespread, severe and long-lasting’ than doctors have been led to believe by years of guidance from the National Institute for Health and Care Excellence (NICE).
Stevie endured a 20-year battle to extricate herself from the grip of a drug she never needed
The new research was carried out on behalf of the All-Party Parliamentary Group for Prescribed Drug Dependence, and is published in the journal Addictive Behaviors.
Researchers looked at 23 studies published over the past 20 years and concluded that 56 per cent of all patients on antidepressants suffer withdrawal symptoms, of which 46 per cent said their symptoms were severe.
The authors estimate that in England alone, where one in six adults takes antidepressants, 4 million people may experience symptoms when withdrawing from the drugs, and around 1.8 million may experience these as severe.
They also found that it’s ‘not uncommon for patients to experience symptoms for several weeks, months or longer’, with some having debilitating symptoms for years.
These findings, say the authors, make a nonsense of the NICE guidance, which advises prescribing doctors that while withdrawal symptoms ‘can be severe’, they are ‘usually mild and self-limiting over about one week’.
The current guidance from NICE ‘is not only out of date but doesn’t respect the evidence base’, says James Davies, co-author of the new paper and a reader in medical anthropology and mental health at the University of Roehampton.
And the personal cost to patients is incalculable. Dr Davies suggests the faulty guidance is causing ‘many doctors to misdiagnose withdrawal symptoms, often as relapse, resulting in unnecessary and harmful long-term prescribing’. That’s because when people come off antidepressants and then experience withdrawal, ‘the doctor looks at the NICE guidelines and concludes it can’t be withdrawal’.
Fact: 56 per cent of all patients on anti-depressants suffer withdrawal symptoms – of which 46 per cent said their symptoms were severe
‘Patients are regularly having their withdrawal reactions either denied, ignored or, most concerningly, misdiagnosed as a relapse in their condition, at which point the drugs are reinstated.’
As a consequence, the length of time people are kept on the drugs has doubled since the guidelines were issued in 2004.
Dr Davies suggests that the existing guidelines have contributed to the doubling over the past decade of the number of adults in England on antidepressants — an escalation he describes as nothing less than ‘a public health crisis’.
It’s important to note that many people say these medications have helped them. However, there is no scientific proof that the drugs do so by reversing a ‘chemical imbalance’. There is also evidence that, for most, they’re no more beneficial than placebos.
‘But unlike placebos, they cause side-effects and withdrawal problems,’ says Dr Davies.
The new review of evidence has been submitted to Public Health England, which is conducting a review into prescription pill dependency, set up in January after a campaign backed by the Mail.
It’s also been sent to NICE, whose current guidance is based chiefly on a paper presented at a psychiatric symposium on ‘antidepressant discontinuation syndrome’ held in Phoenix, Arizona, in the U.S. in December 1996, which was funded by drugs company Eli Lilly.
‘The understanding of anti-depressant withdrawal was significantly shaped by that symposium,’ says Dr Davies. But neither that paper nor a later one relied upon by NICE ‘cites a single source that supports the one-week claim’.
‘We’ve looked very thoroughly for the evidence to support the NICE advice, and there isn’t any,’ adds John Read, a professor of clinical psychology at the University of East London and co-author of the new paper. ‘There’s no way they can put out the same advice again once they’ve read this.’
Dr Joanna Moncrieff, a psychiatrist and leading critic of the overuse of antidepressants, welcomes the research and says it’s imperative NICE updates its guidance.
‘This paper shows that official documents and the psychiatric profession have not taken this issue seriously, not put enough effort into researching it and not wanted to face up to the problems that these drugs can cause,’ she says.
‘We’re giving people these drugs for years on end and we haven’t bothered to work out what happens to them, how that affects the body, and what happens when people stop them. That seems just outrageous, a terrible situation.’
WHAT THE NEW RESEARCH COULD MEAN FOR YOU…
The new research casts doubt on the official view that withdrawal symptoms from antidepressants are usually mild and short-lived, as set out in NICE guidelines and in a recent statement from the Royal College of Psychiatrists (RCP), which said: ‘In the vast majority of patients, any unpleasant symptoms experienced on discontinuing antidepressants have resolved within two weeks’.
In fact, as many as half of patients will experience withdrawal symptoms, with nearly half of those suffering severe effects, the new research has found. ‘We are very much hoping that our research will influence the direction of NICE’s new guidance,’ says Dr James Davies, one of the authors.
Professor John Read, a psychologist and the report’s co-author, adds: ‘We want NICE to acknowledge that antidepressant withdrawal is more common, long-lasting and severe than current guidelines state, and to oblige doctors to warn patients.’
Change may be on its way, though. In comments on the new research Professor Wendy Burn, the RCP’s president, said ‘antidepressants are an effective, evidence-based treatment’ which were ‘a life-saver for many people’.
She adds: ‘But not enough research has been done into what happens when you stop taking them. As this review shows, for many people the withdrawal effects can be severe, particularly when antidepressants are stopped abruptly.
‘We are pleased that Public Health England is prioritising dependence on, and withdrawal from, prescribed medicines as an area of review, and welcome NHS England’s referral to NICE asking that they do the same.’
Many, she believes, would not start taking antidepressants if they knew the battle they might have to get off them. ‘There are lots of people who contact me who have struggled to get off this medication and feel so angry that this was not highlighted to them.
‘This data is now there, and both doctors and patients need to be much more cautious about starting antidepressants in the first place, because it is quite clear that getting off them is not easy for a substantial number of people.’
Among them Stevie Lewis. She decided to come off paroxetine for the first time after taking it for about five months, but within a few days began to suffer ‘tremendous nausea and dizziness’, which lasted for two weeks.
She had no idea it had anything to do with the drug — neither did her doctor, who diagnosed labyrinthitis, an inner-ear disorder affecting balance. In fact, dizziness is a well-documented side-effect of suddenly stopping antidepressants.
In March 1998, Stevie went reluctantly back on the drug after suffering three miscarriages and the death of her mother. ‘Looking back, all I really needed was grief counselling,’ says Stevie, now 63. ‘It’s absurd, given what I’d gone through, that someone could suggest I was feeling low because of a chemical imbalance in my brain.’
After a year back on paroxetine, Stevie again decided to quit — ‘but this time I just couldn’t do it’.
Every time she tried, a few days later she’d feel highly anxious and tearful, developing insomnia. Her doctor said it was anxiety disorder and told her to stay on the pills.
It was only in 2002, when she made contact with a support group online, that she realised she’d become dependent on the drug and was experiencing withdrawal from it.
‘It had been a shock to be told I was on the edge of a nervous breakdown, and then another to be told I had a chemical imbalance in my brain — now I was a prescription junkie,’ says Stevie.