The debate has been vigorous in the US “Psychiatric Times” on this subject through February-March this year, and it raises some great points to reflect upon for us all as clinicians and often also as patients taking the medications. Remember always that most of us will benefit from such medications at times of massive overload, and these can be expected to come in today’s world at some or even many points on our life journey.

While most acknowledge some withdrawal symptoms, the meta-analysis of many studies on the use of these drugs does not indicate the withdrawal problems are severe for most, in fact only 3% may experience trouble at a high level (1 in 35). That being noted I want to raise a word of caution about the studies so far, for most have avoided specific reference to withdrawal symptoms as I suspect drug companies didn’t really want them openly spoken too much about. Their reasons may be cynically referred to by some as “mercurial”, but I want to affirm they are also practical, for if we have patient reluctance enhanced by stories of “addiction” and “difficulties” coming off them, they may resist treatment by the Anti-Depressants and face fatal consequences. These drugs are lifesavers, but we now need to address the withdrawal symptoms for some and affirm the patient concerns and help them.

We need care when we examine this subject, and scientists love to quote placebo studies where a patient may report “great benefit” from a placebo (as high as 30%), but also 17% of patients may report discontinuation symptoms after stopping a placebo.  Care is needed here, but our focus is on the patient, and they need to feel “heard” or our clinical relationship breaks down and they will gain no benefit from our interaction with them.

Just a note, that the drugs that appear at this point to have the most prominent withdrawal problems for some are Venlafaxine and Paroxetine, and those with least withdrawal problems appear to be Sertraline and then Fluoxetine the least of all.

All this debate is helpful, as it reminds us that listening to the patient is the key skill we need to fine tune always, and being responsive to their concerns always opens the door to further assistance being able to be given. Trust must not be broken in the therapeutic relationship or all benefit to the patient stops.  It doesn’t matter whether a reaction is “placebo” related or not, take all things seriously and you will find you and the patient will make serious progress.

Dr John C McEwan
At Monarch Psychology Rooms, Greenlane