Many people are clear that without a timely prescription of an antidepressant they would be dead. However, like most things that seem ‘too good to be true ’antidepressant medication has a dark side.
Side Effects Can be Difficult
While adjusting to medication and dependent on the type, people report a range of symptoms including, nausea, anxiety, indigestion, diarrhoea or constipation, loss of appetite, dizziness, insomnia, headaches, sexual dysfunction, weight gain and dry mouth. Many find that if they persist the symptoms pass or become less distressing and worth tolerating for the benefits they receive. A troubling consequence for some is the loss of sexual functioning which has broader relationship consequences and may persist even when medication ceases.
When it’s Time to Stop
Perhaps more disturbing are the consequences for people whose lives and mood improve to the point where they decide they no longer wish to take an antidepressant. While weaning off the drug is relatively painless for some, others become so unwell they decide that they have no choice but to continue. The symptoms may mirror those that originally led to the prescription including dizziness, headache, nausea, insomnia, and irritability and while they typically occur within a few days and are usually transient, can last up to several weeks or months. In some cases, the appearance of symptoms may convince both treating practitioner and patient that the original depression has not resolved, and they cannot manage without pharmacological support for life.
Dr Mark Horowitz, an Australian doctor who took anti-depressant medication for fifteen years, decided to stop and suffered insomnia, panic attacks, dizziness and anxiety of a severity that made him consider suicide. He is not alone as a meta-analysis of discontinuation syndrome by Henssler et al (2024) published in The Lancet reports 1 in 7 or 15% of people will suffer, with 3% experiencing severe symptoms. The added difficulty is that many of those who prescribe are poorly informed as to how to deprescribe.
The Maudsley Deprescribing Guidelines
Dr Horowitz persisted, and also made understanding of this process his research focus, resulting in the publication of The Maudsley Deprescribing Guidelines with co-author Prof David Taylor. This is in line with the 2023 World Health Organisation and the United Nations call ‘for patients, as a human right, to be informed of their right to discontinue treatment and to receive support to do so’ with the acknowledgement that this area of practice is poorly represented in medical education and few clinicians have the necessary expertise. The guidelines provide evidence-based support and an overview of principles for de-prescribing derived from fundamental scientific principles and research. These guidelines have now been endorsed by the Royal Australian College of General Practitioners.
In Conclusion
While most practitioner’s primary focus is our client’s individual or socio-relational world, all of us are encased in a physical body that contributes to both well-being and distress. In 2021-22, 31 million prescriptions for anti-depressant medication were written in Australia, accounting for 1 in 7 people. With the success of our work or that of medication, our clients may decide it is time to cease and in doing so experience distressing symptoms. Understanding that these may be a result of withdrawal and not a failure to change means we can support them and their doctor to successfully manage them through a challenging and potentially life-threatening process.
Henssler,J. Schmidt,Y., Schmidt,U., Schwarzer,G., Bschor,T., Baethg,C.(2024) Incidence of antidepressant discontinuation symptoms: a systematic review and meta-analysis Lancet Psychiatry 11: 526–35
